Enabling Focused Biomarker Research for Chronic Inflammatory Airway Disease

Published on: 16 Feb 2021, under Breath Biopsy

Respiratory Diseases RUO Panel Infographic PNG

Chronic inflammatory airway disease encompasses a complex range of heterogeneous respiratory diseases with a range of phenotypes and highly similar clinical presentations. There is a significant clinical need for reliable diagnostics to differentiate chronic airway diseases and support selection and development of appropriate treatments. Presently there are no reliable, patient-friendly and cost- effective methods of diagnosis available and trial and error is widely used to find effective treatments. We recently introduced a Breath Biopsy® Research Use Only (RUO) Panel of compounds designed to advance biomarker research on respiratory diseases and facilitate the creation of non-invasive tests for use in precision medicine.


Globally over 500 million people are affected by chronic inflammatory airway diseases1. These conditions include chronic obstructive pulmonary disease (COPD), the world’s third largest cause of death, as well as asthma, idiopathic pulmonary fibrosis (IPF) and interstitial lung disease (ILD). Inflammation and immunological activity in the lungs are key drivers of all of these diseases, yet the specific mechanisms vary between patients.

As an example, asthma can be divided into four endotypes on the basis of the types of inflammatory responses observed in patients. Cases can be dominated by neutrophils, eosinophils, neither (paucigranulocytic) or both (mixed). Around 40% of cases are eosinophilic and a similar number are paucigranulocytic, while the rest are either neutrophilic (15%) or mixed (5%)2. Generally eosinophilic cases respond well to inhaled corticosteroid (ICS) treatments but this is not the case for neutrophilic asthmas. Currently, there’s no reliable way to differentiate between asthma types in a clinical setting.

Breath biomarkers for chronic inflammatory airway disease

Breath testing offers a non-invasive method for assessing chronic airway diseases. This is already demonstrated through nitric oxide (NO) tests, which offer a limited insight into lung health. Breath biomarkers can report on changes in the airways as well as systemic metabolic shifts by detecting compounds exchanged into the air from the blood. While breath testing is not in widespread clinical use, the stable and sensitive technologies that underpin Breath Biopsy are supporting a rapidly growing area of biomarker research for clinical applications. 

Breath Biopsy is the world-leader for robust, reliable breath biomarker discovery and reproducible analysis. Human breath contains over 1000 different volatile organic compounds (VOCs) that can be collected and analyzed using Breath Biopsy. We developed the Breath Biopsy RUO Panel for Respiratory Diseases to drive meaningful research progress towards clinically relevant breath tests. 

The Panel is a curated collection of prospective biomarkers that are selected on the basis of our own research studies, published peer-reviewed work and established biological and mechanistic insights. The Panel already includes representatives from a range of VOC families and spans various biological processes associated with airway inflammation, with more being added as new evidence emerges. A rigorous process also ensures that all compounds in the Panel are suitable for reliable and reproducible high-sensitivity detection using Breath Biopsy.

VOC families
Table 1: The groups of VOCs represented by the compounds included in the first iteration of the Breath Biopsy RUO Panel for Respiratory Diseases

You can see which VOCs are included in the Panel by downloading our poster:

Show me the Panel VOCs

The Panel is now available as a component of our Breath Biopsy Services and can be integrated into the Breath Biopsy OMNI Assay alongside our existing biomarker discovery workflows. This means you can choose to focus your study specifically on the compounds in the Panel, or include the Panel as part of your wider biomarker discovery research. Whichever you choose, our Panel offers you high confidence biomarker identification supported by reliable biological evidence, and tailored data reporting options including statistical analysis and interpretation to suit your needs.

Applications in chronic inflammatory airway disease research

We have designed Breath Biopsy to be versatile and our analysis methods can adapt to a wide range of study designs and limitations. By focusing on a smaller number of VOCs, the Panel makes it easier to detect associations between these VOCs and respiratory diseases. It’s therefore particularly ideal for small-scale pilot studies where reduced sample sizes can lead to overfitting of data. If your results are interesting, we can then discuss expanding your study including more extensive analyses of the samples you’ve already collected can be performed.

The Panel also has applications in drug development. Increasingly, therapeutics developed to target specific disease mechanisms. These drugs are only useful for patients with the relevant disease endotype, so reliable molecular diagnostics are vital for both drug development and deployment. The ability to monitor and detect treatment response early could accelerate the development process, while matching VOC biomarkers to drug mechanisms makes the use of breath sampling well suited for developing complementary diagnostics to new therapeutics. Acute exacerbations of symptoms are also a feature of many respiratory diseases. The ability to detect and anticipate their onset has many potential applications for disease treatment and management, yet currently no reliable biomarkers exist and invasive approaches are impractical for ongoing monitoring. Breath samples can be taken frequently and without drastic inconvenience to patients, the Panel could facilitate the development of a monitoring tool that could assess the extent of disease control and predict exacerbations. 

The Breath Biopsy Panel for Respiratory Diseases is available for use in academic and industry research now. Watch our webinar on Breath Biopsy for Respiratory Diseases to find out more about the applications of Breath Biopsy or get in touch to discuss integrating Breath Biopsy into your studies. 

add the Breath biopsy panel to my study

Respiratory Diseases RUO Panel overview


  1. Labaki, W.W., Han, M.K., Chronic respiratory diseases: a global view Lancet Resp Med 8 (6), 531-533 (2020) https://doi.org/10.1016/S2213-2600(20)30157-0 
  2. Schleich, F.N., Manise, M., Sele, J. et al. Distribution of sputum cellular phenotype in a large asthma cohort: predicting factors for eosinophilic vs neutrophilic inflammation. BMC Pulm Med 13, 11 (2013). https://doi.org/10.1186/1471-2466-13-11