Because pharmacologic treatment of patients with the established Acute Respiratory Distress Syndrome (ARDS) has not been successful, the emphasis on discovering biomarkers that predict ARDS development in at-risk individuals is being rekindled so that ways of preventing ARDS can be advanced and tested. However, the low incidence of ARDS in at-risk individuals, the variable time between becoming at risk and developing ARDS, and the varying incidence of ARDS following different predisposing conditions makes finding clinically-useful ARDS predicting biomarkers challenging. Ideally, biomarkers reflecting ARDS development will be obtainable non-invasively and repeatedly and provide sensitive, specific, accurate and real time results. Biomarkers will also likely need to mirror key events in the pathogenesis of ARDS and meaningfully reflect the effect of therapies on ARDS development. At the moment, analysis of potential biomarkers in breath samples offers an intriguing way of addressing these objectives. A number of ARDS implicated molecules (e.g. hydrogen peroxide, nitric oxide, lipid peroxidation byproducts, cytokeratins) are measurable in breath or breath condensates from ARDS patients. Moreover, powerful new approaches (e.g. proton transfer reaction mass spectrometry, carbon nanotubes analyses using aptamer based multiplexed proteomic technology and cavity-enhanced frequency comb spectroscopy) are emerging that may provide biomarkers that could generate insight regarding the responsible mechanisms for ARDS, monitor ARDS development, enable testing of new ARDS interventions, and guide treating and preventing ARDS.

Breath Biomarkers and the Acute Respiratory Distress Syndrome

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