title: Volatile organic compounds in asthma diagnosis: a systematic review and meta-analysis.
abstract: We aimed to assess the value and classification rate of exhaled volatile organic compounds (VOCs) in asthma diagnosis. A PRISMA-oriented systematic search for published studies regarding exhaled VOCs in asthma diagnosis was conducted based on predefined criteria. Studies presenting sensitivity and specificity values for the test were included in the meta-analysis. Pooled diagnosis odds ratios (DOR), area under the curve (AUC) and positive and negative likelihood ratios (LR) for exhaled VOC profiles were calculated; and publication bias, threshold effect and heterogeneity were estimated. Eighteen studies were selected for the qualitative analysis and six met the criteria for inclusion in the quantitative analysis. Mean (95% CI) pooled DOR, positive and negative LR were 49.3 (15.9-153.3), 5.86 (3.07-11.21) and 0.16 (0.10-0.26), respectively. The AUC value was 0.94. Only three of the 18 reviewed studies performed an external validation of the model using a different data set. The results from the revised studies suggest that exhaled VOCs are promising biomarkers for asthma diagnosis and that several compounds, mainly alkanes, may be significantly associated with asthma inflammation. However, there are still various constraints associated with standardization and externally validated studies are needed to introduce exhaled VOC profiling in a clinical scenario.
authors.affiliation: GEAC, INEGI - Institute of Science and Innovation in Mechanical Engineering and Industrial Management, Porto, Portugal.|Faculty of Medicine of the University of Porto, Portugal & Centro Hospitalar São João E.P.E., Porto, Portugal.
authors.forename: J Cavaleiro
authors.initials: JC
authors.lastname: Rufo
authors.affiliation: GEAC, INEGI - Institute of Science and Innovation in Mechanical Engineering and Industrial Management, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Madureira
authors.affiliation: GEAC, INEGI - Institute of Science and Innovation in Mechanical Engineering and Industrial Management, Porto, Portugal.
authors.forename: E Oliveira
authors.initials: EO
authors.lastname: Fernandes
authors.affiliation: Faculty of Medicine of the University of Porto, Portugal & Centro Hospitalar São João E.P.E., Porto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Moreira
mesh_terms: D001249:Asthma / Q000175:diagnosis* / Q000378:metabolism*; D015415:Biomarkers; D003937:Diagnosis, Differential; D045853:Exhalation; D006801:Humans; D016017:Odds Ratio; D017594:Publication Bias; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055549:Volatile Organic Compounds
chemical_list: D015415:Biomarkers; D055549:Volatile Organic Compounds
keywords: asthma; diagnosis; exhaled biomarkers; volatile organic compounds