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Published ahead of print on November 10, 2005, doi:10.1164/rccm.200507-1059OC
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American Journal of Respiratory and Critical Care Medicine Vol 173. pp. 386-392, (2006)
© 2006 American Thoracic Society
doi: 10.1164/rccm.200507-1059OC

Original Article

The Effects of Volatile Salivary Acids and Bases on Exhaled Breath Condensate pH

Richard M. Effros, Richard Casaburi, Jennifer Su, Marshall Dunning, John Torday, Julie Biller and Reza Shaker

Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; and Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin

Correspondence and requests for reprints should be addressed to Richard M. Effros, M.D., LABiomed–Harbor–UCLA Medical Center, 1124 West Carson Street, RB2, Torrance, CA 90502-2064. E-mail: reffros{at}labiomed.org

Rationale: Recent studies have reported acidification of exhaled breath condensate (EBC) in inflammatory lung diseases. This phenomenon, designated "acidopnea," has been attributed to airway inflammation.

Objectives: To determine whether salivary acids and bases can influence EBC pH in chronic obstructive pulmonary disease (COPD).

Methods: Measurements were made of pH, electrolytes, and volatile bases and acids in saliva and EBC equilibrated with air in 10 healthy subjects and 10 patients.

Results: The average EBC pH in COPD was reduced (normal, 7.24 ± 0.24 SEM; range, 6.11–8.34; COPD, 6.67 ± 0.18; range, 5.74–7.64; p = 0.079). EBCs were well buffered by NH4+/NH3 and CO2/HCO3– in all but four patients, who had NH4+ concentrations under 60 µmol/L, and acetate concentrations that approached or exceeded those of NH4+. Saliva contained high concentrations of acetate (~ 6,000 µmol/L) and NH4+ (~ 12,000 µmol/L). EBC acetate increased and EBC NH4+ decreased when salivary pH was low, consistent with a salivary source for these volatile constituents. Nonvolatile acids did not play a significant role in determining pH of condensates because of extreme dilution of respiratory droplets by water vapor (~ 1:12,000). Transfer of both acetic acid and NH3 from the saliva to the EBC was in the gas phase rather than droplets.

Conclusions: EBC acidification in COPD can be affected by the balance of volatile salivary acids and bases, suggesting that EBC pH may not be a reliable marker of airway acidification. Salivary acidification may play an important role in acidopnea.

Key Words: acetate • ammonium • bicarbonate • buffer • exhaled breath condensate




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