Atemkondensat: Eine neue Matrix zur Erfassung entzündlicher Veränderungen der Atemwege/Lunge[*]

Zusammenfassung

Viele umwelt- und berufsbedingte Schadstoffe gelangen durch die Atemwege in den menschlichen Organismus und können entzündliche Prozesse induzieren. Dabei sind Entzündungsreaktionen grundlegende pathophysiologische Prozesse in der Genese von Atemwegserkrankungen wie dem Asthma oder der chronisch obstruktiven Lungenerkrankung. Der Einsatz nicht-invasiver Methoden zur Bestimmung der zugrunde liegenden Inflammation kann bei der Diagnosefindung, Beurteilung der Erkrankungsschwere sowie von therapeutischen Interventionen hilfreich sein. Von diesen Methoden ist die Messung des Stickstoffmonoxid-Gehaltes in der ausgeatmeten Luft am besten validiert. Sie wird zunehmend auch bei klinischen Fragestellungen zur Asthmaerkrankung eingesetzt. Das Atemkondensat (EBC) entspricht der flüssigen Phase der ausgeatmeten Luft, welche ebenfalls nicht-invasiv durch Kühlung gewonnen wird. Das EBC ist, vergleichbar mit Blut oder Urin, dabei selbst kein Marker, sondern eine Matrix, in der vielfältige Substanzen enthalten sind. Änderungen des Säure-Basen-Haushalts, oxidativer Stress oder Entzündungsreaktionen können durch verschiedene Biomarker im EBC erfasst werden. Weiterhin sind methodische Limitationen anzuführen; die Interpretation der Ergebnisse wird dadurch beeinträchtigt, dass sich die Sammelsysteme in ihrer Effizienz unterscheiden und die eingesetzten analytischen Verfahren im Bereich ihrer Nachweisgrenzen arbeiten. Trotz ermutigender Ergebnisse steht die unzureichende Standardisierung aktuell einem breiten klinischen Einsatz entgegen. EBC könnte gerade im Bereich der Präventivmedizin eine diagnostische Bereicherung darstellen, da lokale entzündliche Veränderungen häufig funktionellen Veränderungen vorausgehen. Im Zusammenhang mit der Untersuchung von gesundheitlichen Beeinträchtigungen durch Luftverschmutzung liegt ein Schwerpunkt auf Markern des oxidativen Stresses, da Partikel in der Lage sind, die Bildung freier Radikale zu begünstigen. Diese Übersicht stellt aktuelle Forschungsergebnisse zum Einsatz des EBC im Rahmen umwelt- und arbeitsmedizinischer Fragestellungen dar.

Abstract

For many environmental and occupational pollutants the respiratory system represents the route of entry. Inflammation is a fundamental process in the pathophysiological cascade leading to respiratory diseases such as asthma or chronic obstructive pulmonary disease. Non-invasive inflammatory monitoring may assist in the diagnosis as well as assessments of severity and response to treatment. Of these, exhaled nitric oxide is the best validated constituent and is used for assessing airway inflammation in clinical practice, particularly in patients with asthma. Exhaled breath condensate (EBC) is the liquid phase of the exhaled breath sampled by cooling. EBC, like blood or urine, is not a marker itself but a matrix in which a wide variety of substances have already been detected. EBC biomarkers reflect acid stress, oxidative stress, or inflammation. There are still many methodological limitations and the interpretation of findings is hampered by the fact that the most widely used devices differ significantly in their collection efficiency for markers of interest and the analytical technology employed is often near the limit of detection. In spite of promising data, standardisation of the already existing procedures is required for the implementation of EBC in clinical practice. EBC might be of particular interest in preventive medicine since adverse inflammatory processes often precede changes in lung function. Concerning the adverse effects of air pollution, there is a special focus on markers reflecting oxidative stress since air pollutants have the ability to drive free radical reactions. This overview focuses on recent data on EBC obtained from articles concerning applications of exhaled breath analysis in environmental and occupational medical research.

1 In Anlehnung an: Hoffmeyer F, Raulf-Heimsoth M, Brüning T. Exhaled breath condensate and airway inflammation. Curr Opin Allergy Clin Immunol 2009; 9: 16 – 22.

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1 In Anlehnung an: Hoffmeyer F, Raulf-Heimsoth M, Brüning T. Exhaled breath condensate and airway inflammation. Curr Opin Allergy Clin Immunol 2009; 9: 16 – 22.