# Uncovering Non-Invasive Biomarkers in Paediatric Severe Acute Asthma Using Targeted Exhaled Breath Analysis

## TL;DR

This study explores breath analysis to identify non-invasive biomarkers for severe asthma attacks in children, aiming to improve early detection and treatment.

## Contribution

The study introduces targeted exhaled breath metabolomics as a novel non-invasive approach to characterize severe acute asthma in children.

## Key findings

- 25 VOCs were identified, with four being more common and nine having higher concentrations in children with severe acute asthma.
- Longitudinal analysis showed consistent VOC profiles over time, indicating reliable biomarkers.
- Exhaled breath analysis could help in early recognition and prevention of severe asthma attacks in children.

## Abstract

Background: Severe acute asthma (SAA) in children can be life-threatening. There has been a significant rise in paediatric intensive care unit (PICU) admissions due to SAA over the past two decades. While asthma is a heterogeneous disease, its underlying pathophysiological pathways remain underexplored. This study aimed to assess the value of non-invasive targeted exhaled breath metabolomics analysis to better characterise SAA. Methods: Breath samples from 17 children admitted to the PICU with SAA (cases) and 27 children with controlled severe asthma (controls) were analysed using thermal desorption gas chromatography–mass spectrometry (TD-GC-MS). Results: A targeted volatile organic compound (VOC) analysis identified 25 compounds, of which 16 were shared between groups. Four VOCs were significantly more often present in SAA, and nine VOCs exhibited higher concentrations in SAA. Longitudinal analysis of VOCs from follow-up samples of 10 cases showed no significant temporal differences, reinforcing the reproducibility of identified biomarkers. Conclusions: This study exemplifies the potential of exhaled breath analysis to provide insights into the molecular background of SAA. Breath metabolomics may enable early recognition of severe asthma attacks and preventive therapeutic interventions in children with severe asthma.