Exhaled volatile organic compounds and respiratory disease: recent progress and future outlook

The theoretical basis of eVOCs as biomarkers for respiratory disease diagnosis is described, followed by a review of the potential biomarkers that have been proposed as targets from in vitro studies. The utility of these targets is then discussed based on comparison with results from clinical breath studies. The current status of breath research is summarised for various diseases, with emphasis placed on quantitative and targeted studies. Potential for bias highlights several important concepts related to standardization, including practices adopted for compound identification, correction for background inspired VOC levels and computation of mixing ratios. The compiled results underline the need for targeted studies across different analytical platforms to understand how sampling and analytical factors impact eVOC quantification. The impact of environmental VOCs as confounders in breath analysis is discussed alongside the potential that eVOCs have as biomarkers of air pollution exposure and future perspectives on clinical breath sampling are provided.