Use of a Modern Breath Sampling System (the Pneumopipe® Combined With an Array of E-nose Sensors) for the Prediction of Treatment Response in Persistent Asthmatic Children
Use of a Modern Breath Sampling System (the Pneumopipe® Combined With an Array of E-nose Sensors) for the Prediction of Treatment Response in Persistent Asthmatic Children
Due to a large disease heterogeneity, the proper management of childhood asthma may be a
 challenging task. Despite the screening of lung function is a fundamental tool, spirometry
 alone may not allow a reliable prediction of the disease prognosis, such as treatment
 response and asthma exacerbations.

 Recently, it has been shown that the detection of volatile organic compounds (VOCs) in
 exhaled breath (Breathomics) is able to predict asthma exacerbations and to discriminate
 children with persistently controlled asthma from those with uncontrolled asthma. These
 studies have been realized through gas chromatography / mass spectroscopy techniques, which
 also provide information on specific compounds useful for pathophysiologic research; however,
 they are expensive and time consuming.

 An alternative approach, scarcely adopted so far, is based on cross-reactive nonspecific
 sensor arrays (e-noses), which may provide valuable information on disease status through
 pattern recognition algorithms or discriminant analyses of the global sensor response pattern
 (breath-fingerprint). In particular, the Pneumopipe® (European patent 12425057.2, Rome,
 Italy) is a recent and innovative device allowing direct absorption of VOCs on a cartridge
 after an individual has normally breathed in it for 3 min. It is a very simple and cheap
 procedure, suitable for non-collaborative populations. Moreover, cartridges may be preferable
 over sampling bags in terms of preservation and transportability. This modern breath sampling
 system provides repeatable measurements, and negligible overlap has been observed with
 information provided by spirometry.

 The main objective of the present study is to assess whether baseline (pre-treatment)
 spirometry and e-nose measurements may predict asthma prognosis in persistent asthmatic
 children, in terms of response to the prescribed treatment with inhaled steroid (ICS), and to
 provide simple rules for discriminating treatment responders and non-responders. The
 secondary aim is to assess e-nose ability to predict asthma exacerbations, disease control
 and adherence.
Inclusion criteria:

 -  male or female gender

 -  age between 6 and 16 years

 -  first asthma diagnosis according to GINA recommendations (http://ginasthma.org),
 including assessment of the history of respiratory symptoms (wheezing, shortness of
 breath, chest tightness and cough) and environmental exposures (smoke, mold, vehicular
 traffic), spirometry (FEV1/FVC<0.90 at baseline, >12% FEV1 increase from baseline
 after bronchodilator inhalation) and skin prick tests.

 Exclusion criteria:

 -  exacerbations requiring oral corticosteroids in the last four weeks

 -  use of controller medications (leukotriene receptor antagonists and/or inhaled
 corticosteroids) in the last four weeks

 -  respiratory infections in the last four weeks

 -  immunological, metabolic, cardiac or neurological diseases

 -  major malformations of the respiratory system

 -  active smoking.