Published ahead of print on November 10, 2005, doi:10.1164/rccm.200507-1059OC
Am. J. Respir. Crit. Care Med., Volume 173, Number 4, February 2006, 386-392
A more recent version of this article appeared on February 15, 2006
Submitted on July 10, 2005
Accepted on November 9, 2005
The Effects of Volatile Salivary Acids and Bases upon Exhaled Breath Condensate pH
Richard M Effros1*, Richard Casaburi2, Jennifer Su2, Marshall Dunning3, John Torday2, Julie Biller3, and Reza Shaker3
1 Department of Medicine, Los Angeles Biomedical Research Institute at Harbor- UCLA Medical Center, Torrance, CA, USA; Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA,
2 Department of Medicine, Los Angeles Biomedical Research Institute at Harbor- UCLA Medical Center, Torrance, CA, USA,
3 Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
* To whom correspondence should be addressed. 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 of 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 4 patients, who had NH4+ concentrations under 60 micromoles/liter and acetate concentrations that approached or exceeded those of NH4+. Saliva contained high concentrations of acetate (~6,000 µM) and NH4+ (~12,000 µM). 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 chronic obstructive pulmonary disease 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: Exhaled breath condensate, buffer, ammonium, bicarbonate, acetate
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