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Asthma in children could be diagnosed by smell

The Midlands Asthma and Allergy Research Association (MAARA) - an East Midlands based charity which funds research into the causes and treatment of asthma and allergy - has approved grants totalling £230,000 over the next five years for a number of projects in the East Midlands area.

One of those is the E-NOSE project which hopes to find more precise ways of diagnosing and monitoring children with asthma. Using state-of-the-art electronic chemical analysers, the project will allow medical professionals to "sniff" out the respiratory condition from childrens' breath. This is just one example of the precision medicine research currently being undertaken at the University of Leicester. With no asthma diagnosing device currently in existence, the pioneering work being carried out by University of Leicester researchers could even be a world first. The benefits are great and, although it's still early days for the project, the next steps are already known.

Following a study published in the British Journal of General Practice, it's believed that half a million children in Britain have been misdiagnosed with asthma. While some tools to help with diagnosis already exist, current tests are neither perfect nor applicable to children under the age of five, and this is why the University of Leicester is looking for better alternatives in the E-NOSE study.

Click here to find out what happened when the News Centre's Nathan Ifill was examined with current methods by the team at Leicester Royal Infirmary:

Sniffing out asthma

"We know people produce lots and lots of smells, and these smells come out from your skin, but they also come out in your breath." said University of Leicester Senior Lecturer Dr Hitesh Pandya.

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Prakash Patel, Senior Paedriatic Respiratory Physiologist, who will be performing some of the tests as part of the study.

A paediatrician by training, Dr Pandya's interest is in asthma. He's one of the members of the East Midlands Breathomics Department working on E-NOSE and finding new chemicals that diagnose and monitor the condition. "You may have seen some months ago, there was a dog specially trained to sniff out prostate cancer...it's technically possible to smell specific scents that predict disease or diagnose disease. What we don't know is which smell, what chemical predicts for asthma." That's what the E-NOSE study is about - to look at whole range of people, with or without asthma, to try and pick out that one or two chemicals that indicate who does and doesn't have the condition.

Another world first for the university

It's very difficult to diagnose asthma in both adults and children. In fact, at the moment, there's no specific test for asthma anywhere in the world. The aim of the E-NOSE project is to have a device in place so that when someone goes to their GP or hospital with symptoms, health professionals can do one test to determine whether their symptoms are due to asthma. As no such device currently exists anywhere across the globe, this could be another world first for the university.

The University of Leicester is the only UK university specifically funded by the Medical Research Council (MRC) to do this work. While the Midlands Asthma and Allergy Research Association (MAARA) funded the project on asthma and childrens' breath, the MRC funded the core infrastructure - both human and equipment - to make it all possible.

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Current tests can't specifically diagnose asthma

The benefits

The E-NOSE will be the next generation tool that would replace the nitric oxide tests currently being used. Although the current tests are so sensitive that they can count the number of nitric oxide molecules per billion molecules of air, they're not as useful for determining whether or not you are an asthmatic. Many things can raise your nitric oxide level such as a cold or hayfever, and a higher level merely shows bruising, not specifically bruising due to asthma.

Dr Hemant Kulkarni is a consultant in paediatric and respiratory medicine who runs the asthma clinic with Dr Pandya. Although not part of the E-NOSE project, he can see the many benefits of the study from the perspective of a medical professional. "This could help us in the day to day control of asthma," he said. The tool would not only be useful for diagnosing the condition, but also helping sufferers to manage it on a daily basis.

Dr Pandya hinted at the possibility of the project developing a phone app: "That would be the ultimate dream," he said. "Not necessarily having lots of different machines that you carry around, but a test that you can match onto or add onto devices that you've already got." Dr Kulkarni believes that if such an app could send out data to GPs or asthma specialists, it would be beneficial for medical professionals as well as the asthma sufferers themselves: "Having objective data would help in better management."

Prakash Patel is a Senior Paedriatic Respiratory Physiologist who will be performing some of the tests as part of the project. He welcomes the research and the reliability that the E-NOSE could bring: "Rather than doing a whole battery of tests, maybe one device could tick it specifically."

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L-R: Prakash Patel, Dr Hitesh Pandya and Dr Hemant Kulkarni

Next steps

These advancements will not happen overnight. The next step is doing a clinical study, sampling the breath of lots of people - adults, children, both with and without asthma. While Dr Pandya and the team at Leicester Royal Infirmary will be at the cutting edge with the clinical patient groups, behind them are a whole group of analytical chemists, mathematicians and statisticians analysing the data sets and looking at which chemicals are specific to asthma sufferers. Some of whom, like Head of the College of Science and Engineering Professor Paul Monks, were involved in an early study “sniffing out” ripeness in mangoes and will have experience in finding chemical signatures like those which indicate that someone has asthma. "Eventually, we'll be putting this data forward to engineers," Pandya said. "There's a pathway to device engineering, from finding the chemicals to producing a readily usable device."

More breakthrough research

A number of studies to better understand asthma are being conducted by University of Leicester researchers: Dr Erol Gaillard and Professor Andrew Wilson in the Department of Health Sciences are conducting a study into the implementation of objective testing to diagnose asthma in children in primary care; Dr Cat Pashley's project is to identify fungi that may have a detrimental effect on health in asthma and other respiratory diseases; and Dr Sherif Gonem is looking into how air quality impacts people with asthma.

Click here to find out more about all of the MAARA funded projects:

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