The Global Innovation Series is supported by BMW i, a new concept dedicated to providing mobility solutions for the urban environment. It delivers more than purpose-built electric vehicles — it delivers smart mobility services. Visit bmw-i.com or follow @BMWi on Twitter.

We all know about the Breathalyzer, a handheld device used by police officers to determine one's blood alcohol level on the spot. But recent research has discovered some other interesting applications for the digital tool.

Breath alcohol testing devices were first developed in the 1940s, and in 1954, Dr. Robert Borkenstein of the Indiana State Police invented the patented Breathalyzer.

Since then, researchers have advanced the science behind breathalyzers to make the tool even more useful — it can indicate the presence of disease, according to Professor Perena Gouma, director of Stony Brook University's Center for Nanomaterials and Sensor Development. Gouma and several other research teams around the world are making great strides in breath analysis and have high hopes for the application of the technology, since you can "monitor breath content for disease or metabolic malfunction."

"I think breath analysis is the new frontier and the future of medical testing," says Dr. Raed Dweik, professor of medicine and director of the breath analysis program at the Cleveland Clinic. Gouma concurs, citing it as a "disruptive technology" that could change the way people think about diagnostics.

Medical Testing







We breathe in oxygen and exhale carbon dioxide — but there's much more in our breath than that. Science has advanced, and Dweik says we can detect byproducts of lots of things in one breath — our own metabolism, metabolisms of diseases that we have, and gases that entered us from the outside environment. "There’s a rich matrix of compounds that can tell a lot about the state of our health and what diseases we’re suffering from," he says.

Breathalyzers are able to measure these gases and compounds even in very low concentrations — in the parts per million or even billion. Since all of our blood circulates through our lungs and the air we exhale comes from the lungs, one single breath contains a lot of information about what's going on in our blood and in our bodies, helping doctors diagnose and monitor certain conditions.

Dr. Gouma's team's nanosensors utilize resistive semiconducting technology — they make for a scientific yet economic tool (roughly $20 per breathalyzer) that allow her to test for particular chemicals. "We have over 300 different gases in our breath, and we know some of them to be markers of disease," says Gouma. For example, acetone is a marker that indicates blood sugar levels, so you can monitor diabetes with an exhale and avoid having to draw blood, and still know whether you should take medication. The possibility of exhaling instead of having to prick oneself to take blood samples every day could lead to improved compliance for blood sugar monitoring, and lead to an overall improvement in a diabetic patient's quality of life.

The advantage of breath analysis is two-fold: It's non-invasive and non-intrusive. A blood test and even urine tests are somewhat intrusive, but a breath test can be conducted almost anywhere, anytime. It can also be done repeatedly without adverse effects, unlike X-rays, which can lead to damage from radiation exposure.

The key to identifying disease is to develop a sensor for a gas that is only present in the breath of those who are infected. Once researchers can detect more gases and determine that a certain gas is exclusive to a disease, breath analysis will have even more applications for other ailments.

Breathprints

In addition to testing for the presence and levels of certain gases, there's also breathprint analysis — examining the big picture of the thousands of gases in the breath and seeing how one's breathprint is different from another's. This could be useful to compare the breath of someone with the flu and someone without it, and the same goes for kidney or liver disease and eventually, many other diseases.

Dweik's research has shown that breathprints can be quite different between lung cancer patients. Dweik uses an "electronic nose" with 32 sensors — each sensor reacts differently to different compounds in your breath. "When you breathe over these sensors, they change in different ways and create a smellprint that is quite distinct between people who have cancer and people who do not, with 85% accuracy." Of course, medicine isn't perfect, and the drawback to the electronic nose is that Dweik's team doesn’t yet know what compounds in breath give that smell signature — they could say if there is lung cancer or not, but can’t currently indicate why or which gas indicates cancer. Dweik admits that the smellprint shows proof of concept, but is lacking the link to the biology of the cancer. It's a promising field, and smellprints and breathalyzer sensors will need to be used symbiotically to help doctors develop the technology even further. Breathprints should help doctors figure out what gases and compounds are indicative of what diseases, and then attune sensors to detect those compounds.

For now, the lung cancer smellprint is a big step. Lung cancer typically presents itself late — a patient might cough up blood, then have a biopsy done, but by that point, the cancer has advanced. Unlike breast cancer, which can be detected and treated early with annual mammograms, there isn't a screening test for lung cancer, which means that this breath analysis technology could go a long way toward saving lives.

Implications for the Future







"This is going to change medical diagnosis work," says Gouma. An inexpensive, portable handheld breathalyzer can empower individuals to take care of their health. "And that means a lot of better health and welfare, for employers, for insurance, for physicians ... I think it's going to have a great impact, and very soon."

Dweik says the diagnosis and monitoring of diabetes, lung cancer, and kidney and liver disease are the "low-hanging fruit" in this field, and that researchers are looking to get more sensitive sensors to broaden the scope of what a Breathalyzer can detect, including asthma, heart failure and hypertension. "Now the search is on for the next molecule — we’re in the process of discovery, trying to sift through and see which of those compounds are useful and which can be used in medical tests."

"Almost any disease could be detected 40 years down the line," Dweik says. "This is really a whole new field that has huge potential to revolutionize the way we do medical testing and monitoring." And it has profound potential for global health.

Series Supported by BMW i

The Global Innovation Series is supported by BMW i, a new concept dedicated to providing mobility solutions for the urban environment. It delivers more than purpose-built electric vehicles; it delivers smart mobility services within and beyond the car. Visit bmw-i.com or follow @BMWi on Twitter.



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