Volatile organic compounds in exhaled air for asthma management: impact of smoking.

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Background: The identification of new biomarkers to explain endogenous inflammatory mechanisms in asthma has gained interest. Volatile organic compounds (VOC) profile analysis may be an accurate test for asthma diagnosis. Aims and objectives: We aimed to assess whether specific VOCs could serve as potential biomarkers in controlled asthma patients, hypothesizing that their presence differs between asthmatic and healthy individuals and is influenced by smoking status. Methods: Exhaled air samples from 120 controlled asthmatics and 89 healthy controls were collected using BioVOC® and analyzed via gas chromatography–mass spectrometry. The presence of hexanal, heptanal, nonanal, propanoic acid, and nonanoic acid was evaluated, considering their relationship with asthma and tobacco exposure. Results: Controlled asthmatics exhaled propanoic acid less than controls (25.0% vs 53.9%, p < 0.001) but exhaled nonanoic acid more frequently (30.8% vs 15.7%, p = 0.019). These differences persisted regardless of smoking status. Among asthmatics, both "current/former smokers" and "never smokers" exhibited lower propanoic acid exhalation compared to controls (21.0% vs. 55.6% and 29.3% vs 51.4%, p < 0.001). "Current/former smokers" with asthma had higher nonanoic acid exhalation than controls (33.9% vs 11.1%, p = 0.0359). Multivariate regression identified propanoic acid as a protective factor for asthma (OR: 0.2, 95% CI: 0.1-0.4, p < 0.001) and nonanoic acid as a risk factor for asthma (OR: 4.5, 95% CI: 1.8-12.6, p = 0.003). Conclusions: Propanoic and nonanoic acid in exhaled air may serve as biomarkers for asthma, independent of smoking status. VOC analysis could enhance asthma management.

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