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Particles in exhaled air (PExA): non-invasive phenotyping of small airways disease in adult asthma

Journal article
Authors M. Soares
Ekaterina Mirgorodskaya
Hatice Koca Akdeva
Emilia Viklund
M. Richardson
P. Gustafsson
Anna-Carin Olin
S. Siddiqui
Published in Journal of Breath Research
Volume 12
Issue 4
ISSN 1752-7155
Publication year 2018
Published at Institute of Medicine, School of Public Health and Community Medicine
Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Language en
Keywords small airways disease, PExA, asthma, non-invasive technique, physiological tools, surfactant protein-a, endogenous particles, inflammation, questionnaire, obstruction, validation, responses, Biochemistry & Molecular Biology, Respiratory System
Subject categories Internal medicine


Rationale: Asthma is often characterised by inflammation, damage and dysfunction of the small airways, but no standardised biomarkers are available. Objectives: Using a novel approach-particles in exhaled air (PExA)-we sought to (a) sample and analyse abundant protein biomarkers: surfactant protein A (SPA) and albumin in adult asthmatic and healthy patients and (b) relate protein concentrations with physiological markers using phenotyping. Methods: 83 adult asthmatics and 21 healthy volunteers were recruited from a discovery cohort in Leicester, UK, and 32 adult asthmatics as replication cohort from Sweden. Markers of airways closure/small airways dysfunction were evaluated using forced vital capacity, impulse oscillometry and multiple breath washout. SPA/albumin from PEx (PExA sample) were analysed using ELISA and corrected for acquired particle mass. Topological data analysis (TDA) was applied to small airway physiology and PExA protein data to identify phenotypes. Results: PExA manoeuvres were feasible, including severe asthmatic subjects. TDA identified a clinically important phenotype of asthmatic patients with multiple physiological markers of peripheral airway dysfunction, and significantly lower levels of both SPA and albumin. Conclusion: We report that the PExA method is feasible across the spectrum of asthma severity and could be used to identify small airway disease phenotypes.

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