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Comparison of Biomarkers in Exhaled Breath Condensate and Bronchoalveolar Lavage

Department of Thoracic Medicine, St. Vincent's Hospital, Darlinghurst; and University of New South Wales, Randwick, Sydney, Australia

Correspondence and requests for reprints should be addressed to Dr. Deborah H. Yates, Department of Thoracic Medicine, St. Vincent's Hospital, Victoria Street, Darlinghurst, Sydney 2010, Australia. E-mail: deborahy88{at}hotmail.com

Rationale: Exhaled breath condensate (EBC) is increasingly studied as a noninvasive research method of sampling the lungs, measuring several biomarkers. The exact site of origin of substances measured in EBC is unknown, as is the clinical applicability of the technique. Special techniques might be needed to measure EBC biomarkers.

Objectives: To assess biomarker concentrations in clinical disease and investigate the site of origin of EBC, we compared EBC and bronchoalveolar lavage (BAL) biomarkers in 49 patients undergoing bronchoscopy for clinical indications.

Measurements: We measured exhaled nitric oxide, 8-isoprostane, hydrogen peroxide, total nitrogen oxides, pH, total protein, and phospholipid (n = 33) and keratin (n = 15) to assess alveolar and mucinous compartments, respectively. EBC was collected over 10 min using a refrigerated condenser according to European Respiratory Society/American Thoracic Society recommendations, and BAL performed immediately thereafter.

Results: 8-Isoprostane, nitrogen oxides, and pH were significantly higher in EBC than in BAL (3.845 vs. 0.027 ng/ml, 28.4 vs. 3.8 µM, and 7.35 vs. 6.4, respectively; p < 0.001). Hydrogen peroxide showed no difference between EBC and BAL (17.5 vs. 20.6 µM, p = not significant), whereas protein was significantly higher in BAL (33.8 vs. 183.2 µg/ml, p < 0.001). Total phospholipid was also higher in EBC, but keratin showed no difference. No significant correlation was found between EBC and BAL for any of the biomarkers evaluated either before or after correction for dilution.

Conclusions: In clinical disease, markers of inflammation and oxidative stress are easily measurable in EBC using standard laboratory techniques and EBC is readily obtained. However, EBC and BAL markers do not correlate.

Key Words: exhaled breath condensate • bronchoalveolar lavage • biomarkers • oxidative stress • inflammation

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Biomarkers in exhaled breath condensate have been evaluated in several lung diseases in a research setting, but the clinical applicability of this new tool is unknown. What This Study Adds to the Field No correlation was found comparing biomarkers in bronchoalveolar lavage to biomarkers in exhaled breath condensate in a clinical setting for any biomarker. These findings demonstrate that exhaled breath condensate sampling cannot be directly compared with information derived from bronchoalveolar lavage.

 

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