Accuracy of a portable breath meter test for the detection of halitosis in children and adolescents

OBJECTIVES: This study aimed to determine the accuracy of the Breath-Alert™ portable breath meter (BA) for the detection of halitosis in children and adolescents, considering the organoleptic test (OT) as the gold standard in this assessment. METHODS: A cross-sectional study was conducted on 150 children (aged 6-12 years). OT was performed by three independent examiners on a single occasion, obtaining three scores of 0-5 points on the Rosenberg's organoleptic scale. The median of the three evaluations for each child was used for analysis. BA was used according to the manufacturer's instructions, with breath odor scored from 0-5 points. Scores ≥2 on both tests were considered indicative of halitosis. RESULTS: A total of 26 (17.3%) and 23 (15.3%) children were detected with halitosis on the OT and BA tests, respectively. The sensitivity and specificity of the BA scores for the detection of halitosis were 80.76% and 98.38%, respectively. The positive and negative predictive values for BA were 91.3% and 96.06%, respectively. CONCLUSION: In the present study involving children, who require fast, practical examinations, BA proved to be an auxiliary tool to OT for the detection of halitosis in the practice of pediatric dentistry, demonstrating high sensitivity and specificity.

Estudo prospectivo para validação de protocolo único para o teste respiratório com ureia marcada com carbono-13 empregando dois dispositivos diferentes, no diagnóstico da infecção por H. pylori / Prospective study for validation of a single protocol for the 13c-urea breath test using two different devices in the diagnosis of h. pylori infection

ABSTRACT BACKGROUND: 13C-urea breath test (UBT) is the gold-standard, noninvasive method for H. pylori diagnosis. However, there is no uniform standardization of the test. This situation can be unpractical for laboratories running with two or more devices. OBJECTIVE: To perform a prospective comparison validation study of UBT employing one validated protocol for two different devices: BreathID Hp Lab System® (Exalenz Bioscience Ltd, Israel), here called device A and IRIS-Doc2® (Wagner Analysen-Technik, Germany, now Mayoly Spindler Group, France), here called device B, in the diagnosis of H. pylori infection. METHODS: A total of 518 consecutive patients (365 females, 153 males, mean age 53 years) referred for UBT were included. All patients received device A protocol as follow: after at least one hour fasting, patients filled two bags prior to the test, then ingested an aqueous solution containing 75 mg of 13C-urea with a 4.0 g citric acid powder and filled another two bags 15 min after ingesting the test solution. One pair of breath sample bags (before and after ingestion) was analyzed by the two different devices. A delta over baseline (DOB) ≥5‰ indicated H. pylori infection. Statistics: Wilcoxon test, kappa coefficient with 95% CI, Wilson's method. RESULTS: Considering the device A protocol as the gold standard, its comparison with device B showed a sensitivity of 99.3% (95% CI: 96.3-99.9) and a specificity of 98.9% (95% CI: 97.3-99.6). Kappa coefficient was 0.976 (95% IC: 0.956-0.997). CONCLUSION: Correlation between the two devices was excellent and supports a uniform standardization of UBT.

RESUMO CONTEXTO: O teste respiratório com ureia-marcada com carbono-13 (TR-13C) é o método padrão-ouro para o diagnóstico não invasivo da infecção por H. pylori. Apesar disto, não existe uma uniformização de protocolos para a sua realização, trazendo dificuldades operacionais para laboratórios ou clínicas que operam com equipamentos de fabricantes diferentes. OBJETIVO: Estudo prospectivo e comparativo para validação do TR-13C para o diagnóstico de infecção por H. pylori, com emprego de protocolo único para dois equipamentos diferentes, a saber: BreathID Hp Lab System® (Exalenz Bioscience Ltd, Israel), aqui denominado equipamento A e IRIS-Doc2® (Wagner Analysen-Technik, Alemanha, agora Mayoly Spindler Group, França), aqui denominado equipamento B. MÉTODOS: Um total de 518 pacientes (365 mulheres e 153 homens, idade média de 53 anos) consecutivamente encaminhados para a realização do TR-13C foram incluídos no estudo. Todos os participantes realizaram TR-13C, que foi processado e analisado simultaneamente pelos dois equipamentos. Embora os dois equipamentos possuam protocolos independentes previamente validados, foi optado, por sua maior praticidade, pela utilização de um único protocolo, conforme recomendado pelo fabricante do equipamento A, e assim resumido: após jejum mínimo de 1h, foram amostras de ar expirado coletadas em dois pequenos sacos coletores (120 mL), correspondendo ao tempo-zero (amostra-1, controle). Em seguida, os pacientes ingeriram, em até 2 min, uma solução aquosa (200 mL) contendo 75 mg de 13C-ureia e 4,0 gramas de ácido cítrico em pó, adicionado com edulcorante. Uma segunda coleta de ar expirado era realizada 15 min após a ingestão do substrato em dois novos pequenos sacos coletores, correspondendo à amostra-2. Foram considerados positivos para a presença da infecção por H. pylori quando apresentavam um delta over baseline (DOB) igual ou maior que 5‰. Análise estatística foi realizada com o teste de Wilcoxon, coeficiente kappa com IC 95% e método de Wilson. RESULTADOS: Considerando o protocolo do equipamento A como o padrão-ouro, sua comparação com o equipamento B mostrou sensibilidade de 99,3% (IC 95%: 96,3-99,9) e especificidade de 98,9% (IC 95%: 97,3-99,6). O coeficiente kappa observado foi de 0,976 (IC 95%: 0,956-0,997). CONCLUSÃO: A correlação entre os dois equipamentos foi excelente e contribui para uma uniformização de protocolos para TR-13C.

Assessment of the accuracy of portable monitors for halitosis evaluation in subjects without malodor complaint. Are they reliable for clinical practice?

Abstract Halitosis is defined as a foul odor emanated from the oral cavity, with great impact in quality of life and social restraints. Recently, the use of Breath Alert™ in research increased significantly. Halimeter™, another portable device, is often used in clinical practice. Nevertheless, not many studies have verified the accuracy and compared the results of both devices simultaneously. Objective: To verify the accuracy of Breath Alert™ and Halimeter™ in patients without chief complaint of halitosis, using the organoleptic test (OT) as "gold standard." The second aim was to verify whether their concomitant use could enhance the diagnostic accuracy of halitosis. Material and Methods: A cross-sectional analytical study was performed. The quality of expired air of 34 subjects without chief complaint of halitosis was assessed. Two experienced examiners carried out the OT. Afterward, a third blinded examiner performed Halimeter™ (HT) and Breath Alert™ (BA) tests. Results: The OT identified halitosis in 21 subjects (62%). The area under the ROC curve (95% confidence interval) was 0.67 (0.48-0.85) and 0.54 (0.34-0.75) for HT and BA, respectively. The accuracy for HT and BA was 59% and 47%, respectively. The combined usage of HT and BA provided 11 positive results, being 9 subjects (43%) out of the total of 21 positive cases. Conclusions: Halimeter™ and Breath Alert™ were not able to diagnose halitosis in non-complainer subjects at the same level as the organoleptic examination, since their accuracy were low. Our results suggest that such portable devices are not reliable tools to assess halitosis and may neglect or misdiagnose a considerable number of patients in clinical practice.

Using a portable sulfide monitor as a motivational tool: A clinical study.

Aims and Objectives: Bad breath has a significant impact on daily life of those who suffer from it. Oral malodor may rank only behind dental caries and periodontal disease as the cause of patient's visit to dentist. An aim of this study was to use a portable sulfide monitor as a motivational tool for encouraging the patients towards the better oral hygiene by correlating the plaque scores with sulfide monitor scores, and comparing the sulfide monitor scores before and after complete prophylaxis and 3 months after patient motivation. Materials and Methods : 30 patients with chronic periodontitis, having chief complaint of oral malodor participated in this study. At first visit, the plaque scores (P1) and sulfide monitor scores before (BCR1) and after complete oral prophylaxis (BCR2) were taken. Then the patients were motivated towards the better oral hygiene. After 3 months, plaque scores (P2) and sulfide monitor scores (BCR3) were recorded again. Statistical Analysis: It was done using SPSS (student package software for statistical analysis). Paired sample test was performed. Results: Statistically significant reduction in sulfide monitor scores was reported after the complete oral prophylaxis and 3 months after patient motivation. Plaque scores were significantly reduced after a period of 3 months. Plaque scores and breathchecker scores were positively correlated. Conclusion : An intensity of the oral malodor was positively correlated with the plaque scores. The portable sulfide monitor was efficacious in motivating the patients towards the better oral hygiene.

Temperatura do ar exalado, um novo biomarcador no controle da asma: um estudo piloto / Exhaled breath temperature, a new biomarker in asthma control: a pilot study

OBJETIVO: Avaliar se a temperatura do ar exalado (TAE), medida por um método não invasivo, é efetiva no monitoramento de pacientes com asma não controlada. MÉTODOS: Estudo piloto com nove pacientes (sete mulheres e dois homens; média de idade: 39 anos) com diagnóstico de asma por pelo menos um ano e sem uso de tratamento de manutenção por pelo menos três meses antes do início do estudo. Na primeira visita, os pacientes foram submetidos à espirometria e à medida da TAE. Todos os pacientes foram orientados a iniciar tratamento com budesonida/formoterol (200/6 µg) inalatório a cada 12 h por seis semanas. Além disso, os pacientes com asma grave (VEF1 < 60 por cento do previsto) foram orientados a utilizar prednisolona oral (40 mg/dia) por cinco dias. Após seis semanas, os pacientes foram submetidos aos mesmos testes. RESULTADOS: Todos os pacientes relataram melhora dos sintomas de asma; confirmada por um aumento significativo de VEF1 da primeira para a segunda visita (média de VEF1: 56,1 por cento vs. 88,7 por cento do previsto; p < 0,05). Cinco pacientes utilizaram prednisolona oral, mas somente nos cinco dias iniciais do tratamento. Seis pacientes utilizaram doses extras da medicação inalatória (média de tempo de uso de medicação adicional = 2,5 semanas). Houve uma diminuição significativa da TAE entre os momentos de avaliação (média de TAE: 35,1ºC vs. 34,1ºC; p < 0,05). CONCLUSÕES: A asma não controlada, sobretudo durante exacerbações, é acompanhada pela elevação da TAE, que se reduz após o controle adequado da asma, demonstrado pela melhora do VEF1 e dos sintomas referidos. Esses resultados preliminares apontam para o monitoramento da TAE como um parâmetro possível na avaliação do controle da asma.

OBJECTIVE: To evaluate whether the exhaled breath temperature (EBT), measured by a noninvasive method, is an effective means of monitoring patients with uncontrolled asthma. METHODS: A pilot study comprising nine patients (seven women and two men; mean age: 39 years) diagnosed with asthma at least one year prior to the beginning of the study and not having been under maintenance therapy for the last three months. In the first visit, the patients underwent spirometry and measurement of EBT. The patients were then instructed to use inhaled budesonide/formoterol (200/6 µg) every 12 h for six weeks. In addition, the patients with severe asthma (FEV1 < 60 percent of predicted) were instructed to use oral prednisolone (40 mg/day) for five days. After six weeks, the patients underwent the same tests. RESULTS: All of the patients reported an improvement in the symptoms of asthma, as confirmed by a statistically significant increase in FEV1 from the first to the second visit (mean, 56.1 percent vs. 88.7 percent of predicted; p < 0.05). Five patients used oral prednisolone for the first five days of the treatment period. Six patients used additional doses of inhaled budesonide/formoterol (mean duration, 2.5 weeks). The EBT decreased significantly from the first to the second visit (mean EBT: 35.1ºC vs. 34.1ºC; p < 0.05). CONCLUSIONS: Uncontrolled asthma, especially during exacerbations, is followed by an increase in EBT, which decreases after appropriate asthma control, as demonstrated by an increase in FEV1 and an improvement of the reported symptoms. These preliminary results suggest that EBT can be used as a parameter for the assessment of asthma control.

Exhaled breath condensate collection for nitrite dosage: a safe and low cost adaptation / Coleta do condensado do ar exalado pulmonar para a dosagem de nitrito: Uma adaptação segura e barata

Purpose: Standardization of a simple and low cost technique of exhaled breath condensate (EBC) collection to measure nitrite. Methods: Two devices were mounted in polystyrene boxes filled either with crushed ice/salt crystals or dry ice/crushed ice. Blood samples were stored at -70º C for posterior nitrite dosages by chemiluminescence and the Griess reaction. Results: a) The use of crushed ice/dry ice or salt revealed sufficient EBC room air collection, but was not efficient for patients under ventilation support; b) the method using crushed ice/salt collected greater EBC volumes, but the nitrite concentrations were not proportional to the volume collected; c) The EBC nitrite values were higher in the surgical group using both methods; d) In the surgical group the nasal clip use diminished the EBC nitrite concentrations in both methods. Conclusions: The exhaled breath condensate (EBC) methodology collection was efficient on room air breathing. Either cooling methods provided successful EBC collections showing that it is possible to diminish costs, and, amongst the two used methods, the one using crushed ice/salt crystals revealed better efficiency compared to the dry ice method.

Objetivo: Padronizar técnica simples e barata de coleta do condensado do ar exalado pulmonar (CEP) para medir nitrito. Métodos: Dois dispositivos foram montados em caixas de isopor e preenchidos com gelo picado/sal grosso ou gelo picado/gelo seco. Amostras de sangue foram armazenadas a -70º C para dosagem de nitrito por quimiluminescência e pela reação de Griess. Resultados: a) a utilização de gelo picado/gelo seco ou sal foi eficiente para a coleta em respiração espontânea, mas ineficiente durante ventilação mecânica; b) o método gelo picado/sal coletou volumes maiores, sem aumento proporcional do nitrito; c) os valores do nitrito foram mais elevados no grupo cirúrgico utilizando os dois métodos; d) no grupo cirúrgico com clipe nasal ocorreu diminuição do nitrito em ambos os métodos. Conclusões: A metodologia do condensado do ar exalado pulmonar (CEP) foi eficiente na coleta respirando em ar ambiente. Os dois métodos de congelamento foram eficientes mostrando que é possível diminuir os custos, e, entre os dois métodos utilizados, o uso de gelo picado/sal mostrou melhor eficiência quanto ao volume da coleta do CEP em comparação com o uso de gelo seco.

Comparação entre o uso de bocal e máscara facial na avaliação de volumes pulmonares e capacidade vital em indivíduos saudáveis / Comparison between the use of mouthpiece and facemask in assessing lung volumes and vital capacity in healthy subjects

Testes de função pulmonar são usados para determinar a gravidade, as conseqüências funcionais e o progresso de disfunções pulmonares e neuromusculares. As variações metodológicas com o bocal e a máscara facial e a cooperação do paciente podem interferir no desempenho das manobras e afetar as medidas. O objetivo deste estudo foi comparar os valores de volumes pulmonares (volume corrente [Vc], volume-minuto [Vm]), freqüência respiratória (FR) e capacidade vital (CV) em indivíduos saudáveis quando avaliados por meio do bocal e da máscara facial. Participaram do estudo 60 voluntários saudáveis, 14 homens e 46 mulheres, com média de idade de 22,9±7,1 anos. Para a avaliação com bocal, utilizou-se uma peça semirrígida descartável e clipe nasal; a máscara usada foi facial plástica com borda pneumática inflável. As medidas obtidas foram comparadas estatisticamente (nível de significância 5%). Os valores obtidos com o bocal e com a máscara facial foram, respectivamente: FR, 15 rpm x 13 rpm (p<0,01); Vm, 14,87 l/min x 10,02 l/min (p<0,01); Vc, 0,93 l x 0,8 l (p<0,01); CV, 3,85 l x 3,52 l (p<0,01). Os valores de volumes pulmonares e capacidade vital mostraram-se pois significativamente inferiores quando avaliados com a máscara facial em comparação ao bocal...

Respiratory function tests are used to determinate severity, functional consequences and progress of pulmonary and neuromotor dysfunctions. Methodological variations – by means of a mouthpiece or a facemask – and patient’s cooperation may interfere in manoeuvre performance and affect measures. The aim of this study was to compare lung volume values (tidal volume [VT] and minute volume [Vm]), respiratory rate (RR), and vital capacity (VC) in healthy individuals when assessed by using a mouthpiece and a facemask. A total of 60 healthy subjects (14 men and 46 women), mean aged 22.86±7.14 years, were evaluated. Items used were a disposable, semi-rigid mouthpiece, with a nose clip, and a plastic facemask with pneumatic inflatable sealing. Measures obtained were statistically compared, with significance level set at 5%. Mean values obtained with the mouthpiece and the facemask were, respectively: RR, 15 rpm x 13 rpm (p<0.01); Vm, 14.87 l/min x 10.02 l/min (p<0.01); VT, 0.93 l x 0.8 l (p<0.01); and VC, 3.85 l x 3.52 l (p<0.01). Lung volumes and vital capacity values were thus shown to be significantly lower when assessed by means of a facemask than with a mouthpiece...

Diseño y evaluación de un equipo para obtener aire espirado condensado / Design and evaluation of a device for collecting exhaled breath condensate

El análisis de muestras de aire espirado condensado ha cobrado gran relevancia en los últimos años como método no invasivo de estudio de la fisiología y las enfermedades de origen pulmonar. En el presente trabajo se describe un equipo para tomar muestras de aire espirado condensado de bajo costo, fácil de fabricar, de transportar al terreno y que permite tomar muestras en forma simultánea. La concentración de metabolitos relativos a procesos inflamatorios y al daño oxidativo (pH, peróxido de hidrógeno y nitrito) de muestras de aire espirado condensado obtenido con este equipo son comparables a los reportados con otros previamente.

In recent years, the analysis of exhaled breath condensate samples has been given great weight as a noninvasive methodology of studying physiology and lung diseases. The present study describes a device for measuring exhaled breath condensate that is affordable, easily constructed, portable and suitable for use in the field, as well as allowing the collection of simultaneous samples. The results obtained with this device in terms of the concentrations of pH, peroxide oxide and nitrite, metabolites related to inflammatory and oxidative damage, in exhaled breath condensate samples are comparable to those obtained with other devices previously described.

Breath Counter: a new device for household diagnosis of childhood pneumonia.

Illiterate Traditional Birth Attendants (TBAs) were trained to diagnose pneumonia in children using their visual judgement of tachypnoea. This method resulted in 41% wrong diagnosis in the cases with borderline respiratory rate. A simple device, named 'Breath Counter' was designed and TBAs were trained to diagnose pneumonia in children using this instrument. The agreement of TBAs' diagnosis, with diagnosis using WHO criteria of respiratory rate improved from unaided 60% (30/50) to 82% (41/50) by the use of Breath Counter (p less than 0.05). Breath Counter is simple, cheap, effective and can be used even by illiterate persons to diagnose pneumonia in children. It has the potential of becoming a household diagnostic aid.