Ultrasensitive multispecies spectroscopic breath analysis for real-time health monitoring and diagnostics

Breath analysis enables rapid, noninvasive diagnostics, as well as long-term monitoring of human health, through the identification and quantification of exhaled biomarkers. Here, we demonstrate the remarkable capabilities of mid-infrared (mid-IR) cavity-enhanced direct-frequency comb spectroscopy (CE-DFCS) applied to breath analysis. We simultaneously detect and monitor as a function of time four breath biomarkers—CH3OH, CH4, H2O, and HDO—as well as illustrate the feasibility of detecting at least six more (H2CO, C2H6, OCS, C2H4, CS2, and NH3) without modifications to the experimental apparatus. We achieve ultrahigh detection sensitivity at the parts-per-trillion level. This is made possible by the combination of the broadband spectral coverage of a frequency comb, the high spectral resolution afforded by the individual comb teeth, and the sensitivity enhancement resulting from a high-finesse cavity. Exploiting recent advances in frequency comb, optical coating, and photodetector technologies, we can access a large variety of biomarkers with strong carbon–hydrogen-bond spectral signatures in the mid-IR.

Breath analysis is an exceptionally promising and rapidly developing field of research, which examines the molecular composition of exhaled breath (1–6). The hundreds of different gases that are present in exhaled breath include inorganic compounds, as well as volatile organic compounds (VOCs), and can either result from internal metabolic activity (endogenous emissions) or external factors, such as food consumption or environmental exposure (exogenous emissions). Despite its distinctive advantages of being a rapid, noninvasive technique and its long history dating back to Hippocrates, breath analysis has not yet been as widely deployed for routine diagnostics and monitoring as other methods, such as blood-based analysis. This is partly due to the experimental challenges of dealing with extremely small amounts of gas-phase molecules—in the parts-per-million (ppm) to parts-per-billion (ppb) range for most VOCs—and partly due to the relative scarcity of large-scale clinical studies that can reliably correlate specific diseases with biomarkers present in breath. Nevertheless, through close collaborations between instrument developers, breath-analysis experts, and clinicians, the field of breath analysis is fast approaching its goal of enabling real-time, noninvasive early detection and long-term monitoring of temporary and permanent health conditions (1, 3). Several biomarkers present in breath have been associated with specific conditions—for instance, nitrogen monoxide with asthma, acetone with diabetes, and ammonia with renal failure (5)—and breath is increasingly being used to track diseases and infections, both bacterial and viral (7). Recently, three studies have demonstrated the use of breath analysis to discriminate between SARS-CoV-2–infected patients and patients affected by other conditions (including asthma, chronic obstructive pulmonary disease, bacterial pneumonia, and cardiac conditions) (8, 9) or influenza A-infected patients (10). The possibility of real-time testing for highly infectious diseases in a noninvasive manner, without the need for chemical reagents and complex laboratory facilities, is particularly appealing in view of the current global pandemic.Technologies being explored and adopted for breath analysis include mass spectrometry, nanomaterial-based sensors, and laser spectroscopy. To date, the most widely used analytical technique in breath research is gas chromatography combined with mass spectrometry, which allows for the sensitive detection of hundreds of exhaled molecules, albeit with relatively long analysis times (tens of minutes) limited by the elution time of the various species. On the other hand, selected ion-flow-tube mass spectrometry and proton-transfer reaction mass spectrometry allow for real-time breath analysis at the expense of a reduced number of simultaneously detectable molecules (11). Sensor arrays offer an inexpensive and practical alternative for identifying the presence of a class of compounds based on their functional groups, but they generally do not permit identification of the specific molecules present in the samples (9, 12). Laser spectroscopy is intrinsically fast (≪ second timescale), allowing breath-cycle-resolved (i.e., respiratory-phase-resolved) sampling of breath with high precision and absolute accuracy. Achieving high sensitivity requires both signal enhancement and noise reduction: The former is attained by using multipass cells or high-finesse cavities, while the latter is accomplished through intensity or frequency-modulation techniques. Among others, tunable diode laser absorption spectroscopy, cavity ring-down spectroscopy, cavity-enhanced absorption spectroscopy, and photoacoustic spectroscopy have all successfully been employed in breath analysis, but are typically limited in tunability and therefore in the number of detectable analytes (1). Cavity-enhanced direct-frequency comb spectroscopy (CE-DFCS) offers substantially enhanced capabilities for the simultaneous detection of multiple species due to the combination of high spectral resolution, wide spectral coverage, and high sensitivity (13–18). An early study from 2008 demonstrated this by detecting carbon monoxide, carbon dioxide, methane, ammonia, and water in breath samples by CE-DFCS (19). This previous work measured vibrational (mainly first) overtone transitions in the near-infrared (near-IR) region of the spectrum, from 1.5 μm to 1.7 μm.Here, we report a 2-orders-of-magnitude improvement in the detection sensitivity for multiple species relevant to breath analysis by using CE-DFCS in the mid-infrared (mid-IR) molecular fingerprint region (3.4−3.6 μm). We gain access to fundamental vibrational transitions, as well as employ higher-finesse mid-IR cavity mirrors (15, 20), compared to previous work in this spectral region (21). Exploiting recent advances in frequency comb, high-reflectivity optical coating, and photodetector technologies, we can detect a large variety of biomarkers simultaneously, sensitively, and unambiguously, providing exciting prospects to connect breath to a range of biological functions and diseases.