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Breathomics for the clinician: the use of volatile organic compounds in respiratory diseases
  1. Wadah Ibrahim1,2,
  2. Liesl Carr2,
  3. Rebecca Cordell3,
  4. Michael J Wilde3,
  5. Dahlia Salman4,
  6. Paul S Monks3,
  7. Paul Thomas4,
  8. Chris E Brightling1,2,
  9. Salman Siddiqui1,2,
  10. Neil J Greening1,2
  1. 1Department of Respiratory Sciences, University of Leicester, Leicester, UK
  2. 2Institute for Lung Health, Leicester NIHR Biomedical Research Centre, Leicester, UK
  3. 3School of Chemistry, University of Leicester, Leicester, UK
  4. 4Department of Chemistry, Loughborough University, Loughborough, UK
  1. Correspondence to Dr Neil J Greening, Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK; neil.greening{at}


Exhaled breath analysis has the potential to provide valuable insight on the status of various metabolic pathways taking place in the lungs locally and other vital organs, via systemic circulation. For years, volatile organic compounds (VOCs) have been proposed as feasible alternative diagnostic and prognostic biomarkers for different respiratory pathologies.

We reviewed the currently published literature on the discovery of exhaled breath VOCs and their utilisation in various respiratory diseases

Key barriers in the development of clinical breath tests include the lack of unified consensus for breath collection and analysis and the complexity of understanding the relationship between the exhaled VOCs and the underlying metabolic pathways. We present a comprehensive overview, in light of published literature and our experience from coordinating a national breathomics centre, of the progress made to date and some of the key challenges in the field and ways to overcome them. We particularly focus on the relevance of breathomics to clinicians and the valuable insights it adds to diagnostics and disease monitoring.

Breathomics holds great promise and our findings merit further large-scale multicentre diagnostic studies using standardised protocols to help position this novel technology at the centre of respiratory disease diagnostics.

  • exhaled airway markers
  • respiratory infection

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  • Collaborators EMBER Consortium. Ananga Sundari; Beverley Hargadon; Sheila Jones; Bharti Patel; Asia Awal; Rachael Phillips; Teresa McNally; Clare Foxon; Dr. Matthew Richardson; Prof. Toru Suzuki; Prof. Leong L Ng; Dr. Erol Gaillard; Dr. Caroline Beardsmore; Prof. Tim Coates; Dr. Robert C Free; Dr. Bo Zhao; Rosa Peltrini; Luke Bryant; Dorota Ruszkiewicz;

  • Contributors WI and NG conceived the presented review. WI took the lead in writing the manuscript with support from NG and LC. All authors, including RC, MJW, DS, PSM, PT, CB and SS contributed to the writing, reviewing and editing of the manuscript.

  • Funding This review was funded by the Medical Research Council (MRC), Engineering and Physical Sciences Research Council (EPSRC) Stratified Medicine Grant for Molecular Pathology Nodes (Grant No. MR/N005880/1) and Midlands Asthma and Allergy Research Association (MAARA), supported by the NIHR Leicester Biomedical Research Centre and the NIHR Leicester Clinical Research Facility. NG is funded by an NIHR Fellowship (pdf-2017-10-052).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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