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Updated: Aug 9, 2026
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Real-time Breath Analysis by Using Secondary Nanoelectrospray Ionization Coupled to High Resolution Mass Spectrometry
Published on: March 9, 2018
Non-Invasive Estimation of Systemic Drug Exposure Using Exhaled Breath Metabolomics in Humans: A Translational
Kai Fricke1,2, Diego M Baur1,2, Kapil Dev Singh3,4
1Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Clinical Pharmacology and Therapeutics
|August 7, 2026
Summary
This study shows exhaled breath analysis can estimate drug levels non-invasively. Breath tests complement traditional blood monitoring for medications like valproic acid and levetiracetam.
Area of Science:
- Pharmacology
- Analytical Chemistry
- Metabolomics
Background:
- Accurate systemic drug exposure assessment is challenging due to invasive methods and limited temporal resolution.
- Exhaled breath offers a non-invasive matrix for pharmacokinetic sensing due to volatile compounds from drug metabolism.
Purpose of the Study:
- To evaluate exhaled breath metabolomics using SESI-HRMS for estimating systemic drug exposure.
- To assess the concordance of breath-derived drug estimates with serum concentrations for multiple medications.
Main Methods:
- Prospective observational study with 117 adults providing paired breath-serum measurements.
- Exhaled breath metabolomics utilizing secondary electrospray ionization high-resolution mass spectrometry (SESI-HRMS).
- Model performance evaluated using k-fold cross-validation and concordance correlation coefficients.
Main Results:
- Moderate concordance (CCC 0.733–0.895) between breath-derived and serum estimates for valproic acid, levetiracetam, and lamotrigine.
- Preliminary lacosamide findings showed concordance but require larger sample size.
- The 11-feature VPA breath signature demonstrated cross-cohort transferability.
Conclusions:
- Exhaled breath analysis is feasible for non-invasive drug exposure estimation across diverse medications.
- Breath analysis is a complementary tool to serum monitoring, not a replacement.
- Further multicenter and longitudinal validation is necessary for clinical implementation.
