A breath of fresh air?

X-ray of lungs

19 October 2012 by Richard Hollingham

A constant challenge in a busy accident and emergency department is deciding exactly what type of care patients need. Richard Hollingham talks to Paul Monks from the University of Leicester and Tim Coates from Leicester Royal Infirmary, to find out how environmental science could help doctors make that decision.

Richard: I'm in the brand-new diagnostics development unit of Leicester Royal Infirmary - a room full of the sort of equipment you'd expect to find in a physics lab. Paul, can you explain?

Paul: We've taken instruments that we use in the laboratory and outside in the environment for smelling the air - sniffing the chemicals in the air - and we're using them in the hospital to smell people's breath.

This is a proton transfer reaction timer flight mass spectrometer - basically a way of analysing chemicals very quickly. So we sample the molecules on your breath and their chemical composition is shown on the mass spec screen. Certain chemicals can indicate if a patient is suffering from a particular condition, for example acetone is a marker for diabetes. So we hope to be able to actually smell disease.

Exactly the same technology will be used in London to measure air pollution during the Olympics.

Richard: This room is full of equipment but the patients are next door in the emergency department - how does it all work?

Tim: We've got a series of ports through the wall there so we can monitor the patient on the other side without interrupting their treatment. We can monitor even the sickest patients, something that's been really difficult to do in the past.

Paul Monks tests the breath analysis software on Richard Hollingham

Paul Monks tests the breath analysis software on Richard Hollingham.

We're using it on a range of patients to see what sort of results we get, because a lot of this technology is really new to humans. If a patient comes in with a chest infection, the mass spec might be able to detect which bacteria are in their chest from the molecules on their breath. That might help us give them the right antibiotic for their infection. We don't yet know if we can do that, but that's the sort of potential we're looking at.

Once we get consent from the patient we spend about half an hour with them, and it's all non-invasive so it doesn't involve anything unpleasant like blood tests.

Richard: You've got tubes going through the wall - what do you attach to the patients?

Tim: They have a mouthpiece to breath into and also a series of stickers which we use to attach cardiovascular monitors - so we're looking at their heart and lungs. We're also doing some imaging using a hyperspectral imager borrowed from space science.

Richard: How did you decide that putting these different technologies together would be useful in medical diagnostics?

Paul: As with all the best things in science it was serendipity, a conversation in the corridor. We'd been doing the breath analysis for a while in a minor way when I bumped into a colleague in the space research centre who said "Actually we've been working on that." Then we found Tim and it kind of came together. The university gave us half a million pounds to buy the equipment and since then it's mushroomed. It's really a land of opportunity for doing cutting-edge science.

Richard: Do you anticipate actually being able to diagnose some diseases with this or is that a long-term goal?

Tim: That's a medium-term goal. I think with a lot of science people tell you there's a breakthrough and it's going to do this, but they're talking five or ten years away. With this technology we're probably two years away from having something that can really be tested to see if it makes a difference for patients.

We see about 450 patients a day come through this department. The real trick in emergency care is to pick out which of those really need emergency intervention and which can go to their GP or outpatients. We often have difficulty making that decision and sometimes we get it wrong. If technology like this could help pick out patients that really do need our help, that's going to be a benefit.

Richard: For a hospital environment this is a fairly fearsome bit of equipment. I imagine it is also very expensive. You really need to miniaturise this don't you?

Paul: Yes, we're at the discovery phase, so we need big instruments with a lot of functionality to explore human breath. The idea at the end of the day is to miniaturise these things and maybe even produce hand-held diagnostics, something the size of a glasses case that you would be able to breathe into. Maybe even, one day, your mobile phone.

This Q&A is adapted from the Planet Earth Podcast, 6 June 2012.