< Return to Video

What your breath could reveal about your health

  • 0:01 - 0:04
    I have a tendency to assume the worst,
  • 0:04 - 0:07
    and once in a while,
    this habit plays tricks on me.
  • 0:07 - 0:10
    For example, if I feel
    unexpected pain in my body
  • 0:10 - 0:13
    that I have not experienced before
    and that I cannot attribute,
  • 0:13 - 0:18
    then all of a sudden, my mind
    my turn a tense back into heart disease
  • 0:18 - 0:22
    or calf muscle pain into ??.
  • 0:22 - 0:25
    But so far I haven't been diagnosed
    with any deadly or incurable disease.
  • 0:25 - 0:29
    Sometimes things just hurt
    for no clear reason.
  • 0:29 - 0:32
    But not everyone is as lucky as me.
  • 0:32 - 0:36
    Every year, more than
    50 million people die worldwide.
  • 0:36 - 0:40
    Especially in high-income
    economies like ours,
  • 0:40 - 0:44
    a large fraction of deaths
    is caused by slowly progressing diseases:
  • 0:44 - 0:49
    heart disease, chronic lung disease,
    cancer, Alzheimer's, diabetes,
  • 0:49 - 0:52
    just to name a few.
  • 0:52 - 0:57
    Now, humanity has made tremendous progress
    in diagnosing and treating many of these,
  • 0:57 - 1:00
    but we are at stage
    where further advancement in health
  • 1:00 - 1:03
    cannot be achieved only
    by developing new treatments,
  • 1:03 - 1:06
    and this becomes evident
    when we look at one aspect
  • 1:06 - 1:09
    that many of these
    diseases have in common.
  • 1:09 - 1:12
    The probability for successful treatment
  • 1:12 - 1:16
    strongly depends on
    when treatment is started,
  • 1:16 - 1:20
    but a disease is typically only detected
    once symptoms occur,
  • 1:20 - 1:24
    and the problem here is that in fact
    many disease can remain asymptomatic,
  • 1:24 - 1:28
    hence undetected,
    for a long period of time.
  • 1:28 - 1:34
    Because of this, there is
    a persisting need for new ways
  • 1:34 - 1:37
    of detecting disease at early stage,
    way before any symptoms occur.
  • 1:37 - 1:40
    In health care, this is called screening,
  • 1:40 - 1:43
    and as defined by
    the World Health Organization,
  • 1:43 - 1:46
    screening is the
    presumptive identification
  • 1:46 - 1:49
    of unrecognized disease
  • 1:49 - 1:51
    in an apparently healthy person
  • 1:51 - 1:56
    by means of tests that can be applied
    rapidly and easily.
  • 1:56 - 1:58
    That's a long definition,
    so let me repeat it:
  • 1:58 - 2:02
    identification of unrecognized disease
  • 2:02 - 2:05
    in an apparently healthy person
  • 2:05 - 2:09
    by means of tests that can be applied
    both rapidly and easily.
  • 2:09 - 2:12
    And I want to put special emphasis
    on the words "rapidly" and "easily,"
  • 2:12 - 2:14
    because many of
    the existing screening methods
  • 2:14 - 2:16
    are exactly the opposite.
  • 2:16 - 2:19
    And those of you who have gone colonoscopy
  • 2:19 - 2:22
    as part of a screening program
    for colorectal cancer
  • 2:22 - 2:25
    will know what I mean.
  • 2:25 - 2:29
    Obviously, there's a variety
    of medical tools available
  • 2:29 - 2:31
    to perform screening tests.
  • 2:31 - 2:33
    This ranges from imaging techniques
  • 2:33 - 2:36
    such as radiography
    or magnetic resonance imaging
  • 2:36 - 2:39
    to the analysis of blood or tissue.
  • 2:39 - 2:42
    We have all had such tests.
  • 2:42 - 2:46
    But there's one medium
    that for long has been overlooked,
  • 2:46 - 2:49
    a medium that is easily accessible,
  • 2:49 - 2:51
    basically non-depletable,
  • 2:51 - 2:55
    and it holds tremendous promise
    for medical analysis,
  • 2:55 - 2:59
    and that is our breath.
  • 2:59 - 3:03
    Human breath is essentially
    composed of five components:
  • 3:03 - 3:10
    nitrogen, oxygen,
    carbon dioxide, water and argon,
  • 3:10 - 3:13
    but besides these five, there are
    hundreds of other components
  • 3:13 - 3:16
    that are present in very low quantity.
  • 3:16 - 3:18
    These are called volatile
    organic compounds,
  • 3:18 - 3:20
    and we release hundreds,
    even thousands of them,
  • 3:20 - 3:23
    every time we exhale.
  • 3:23 - 3:27
    The analysis of these volatile
    organic compounds in our breath
  • 3:27 - 3:29
    is called breath analysis.
  • 3:29 - 3:33
    In fact, I believe that many of you
    have already experienced breath analysis.
  • 3:33 - 3:37
    Imagine, you're driving home late at night
  • 3:37 - 3:40
    when suddenly there's
    a friendly police officer
  • 3:40 - 3:42
    who asks you kindly but firmly
  • 3:42 - 3:46
    to pull over and blow
    into a device like this one.
  • 3:48 - 3:51
    This is an alcohol breath tester
  • 3:51 - 3:55
    that is used to measure
    the ethanol concentration in your breath
  • 3:55 - 3:59
    and determine whether driving
    in your condition is a clever idea.
  • 3:59 - 4:02
    Now I'd say my driving was pretty good,
  • 4:02 - 4:03
    but let me check.
  • 4:03 - 4:05
    (Beep)
  • 4:09 - 4:12
    0.0, so nothing to worry about, all fine.
  • 4:15 - 4:17
    Now, imagine a device like this one
  • 4:17 - 4:20
    that does not only measure
    alcohol levels in your breath,
  • 4:20 - 4:23
    but that detects diseases
  • 4:23 - 4:26
    like the ones I've shown you
    and potentially many more.
  • 4:27 - 4:31
    The concept of correlating
    the smell of a person's breath
  • 4:31 - 4:33
    with certain medical conditions
  • 4:33 - 4:36
    in fact dates back to Ancient Greece,
  • 4:36 - 4:41
    but only recently, research efforts
    on breath analysis have skyrocketed,
  • 4:41 - 4:45
    and what once was a dream
    is now becoming reality.
  • 4:45 - 4:48
    And let me pull up this list again
    that I showed you earlier.
  • 4:49 - 4:53
    For the majority of diseases listed here,
  • 4:53 - 4:56
    there's substantial scientific evidence
    suggesting that the disease
  • 4:56 - 5:00
    could be detected by breath analysis.
  • 5:00 - 5:02
    But how does it work exactly?
  • 5:02 - 5:05
    The essential part is a sensor device
  • 5:05 - 5:10
    that detects the volatile
    organic compounds in our breath.
  • 5:10 - 5:13
    Simply put, when exposed
    to a breath sample,
  • 5:13 - 5:16
    the sensor outputs a complex signature
  • 5:16 - 5:21
    that results from the mixture of volatile
    organic compounds that we exhale.
  • 5:21 - 5:22
    Now, this signature represents
    a fingerprint of your metabolism,
  • 5:22 - 5:26
    your microbiome,
  • 5:26 - 5:28
    and the biochemical processes
    that occur in your body.
  • 5:28 - 5:32
    If you have a disease,
  • 5:32 - 5:34
    your organisms will change,
  • 5:34 - 5:38
    and so will the composition
    of your exhaled breath,
  • 5:38 - 5:40
    and then the only thing that is left to do
  • 5:40 - 5:43
    is to correlate a certain signature
  • 5:43 - 5:47
    with the presence or absence
    of certain medical conditions.
  • 5:48 - 5:52
    The technology promises
    several undeniable benefits.
  • 5:52 - 5:55
    Firstly, the sensor can be miniaturized
  • 5:55 - 5:58
    and integrated into small,
    handheld devices
  • 5:58 - 6:01
    like this alcohol breath tester.
  • 6:01 - 6:04
    This would allow the test to be used
    in many different settings
  • 6:04 - 6:06
    and even at home,
  • 6:06 - 6:08
    so that a visit at a doctor's office
  • 6:08 - 6:11
    is not needed each time
    a test shall be performed.
  • 6:11 - 6:15
    Secondly, breath analysis is non-invasive
  • 6:15 - 6:18
    and can be as simple as blowing
    into an alcohol breath tester.
  • 6:19 - 6:23
    Such simplicity and ease of use
    would reduce patient burden
  • 6:23 - 6:28
    and provide an incentive
    for broad adoption of the technology.
  • 6:28 - 6:32
    And thirdly, the technology is so flexible
  • 6:32 - 6:35
    that the same device could be used
  • 6:35 - 6:38
    to detect a broad range
    of medical conditions.
  • 6:38 - 6:44
    Breath analysis could be used to screen
    for multiple diseases at the same time.
  • 6:44 - 6:49
    Nowadays, each disease typically requires
  • 6:49 - 6:50
    a different medical tool
    to perform a screening test,
  • 6:50 - 6:54
    but this means you can only find
    what you're looking for.
  • 6:54 - 6:57
    With all of these features,
    breath analysis is predestined
  • 6:57 - 7:03
    to deliver what many traditional
    screening tests are lacking,
  • 7:03 - 7:06
    and most importantly,
    all of these features
  • 7:06 - 7:11
    should eventually provide us
    with a platform for medical analysis
  • 7:11 - 7:16
    that can operate at attractively
    low cost per test.
  • 7:16 - 7:19
    On the contrary, existing medical tools
  • 7:19 - 7:22
    often lead to rather high cost per test.
  • 7:22 - 7:25
    Then, in order to keep costs down,
  • 7:25 - 7:28
    the number of tests
    needs to be restricted,
  • 7:28 - 7:31
    and this means a) that the tests
    can only be performed
  • 7:31 - 7:36
    on a narrow part of the population,
    for example the high-risk population,
  • 7:36 - 7:42
    and b) that the number of tests per person
    needs to be kept at a minimum.
  • 7:42 - 7:44
    But wouldn't it actually be beneficial
  • 7:44 - 7:47
    if the test was performed
    on a larger group of people
  • 7:47 - 7:52
    and more often and over a longer period
    of time for each individual?
  • 7:52 - 7:56
    Especially the latter would give access
    to something very valuable
  • 7:56 - 7:59
    that is called longitudinal data.
  • 7:59 - 8:03
    Longitudinal data is a dataset
    that tracks the same patient
  • 8:03 - 8:08
    over the course of many months or years.
  • 8:08 - 8:10
    Nowadays, medical decisions
  • 8:10 - 8:13
    are often based on a limited dataset
  • 8:13 - 8:16
    where over a glimpse
    of a patient's medical history
  • 8:16 - 8:19
    is available for decision-making.
  • 8:19 - 8:23
    In such a case,
  • 8:23 - 8:24
    abnormalities are typically detected
  • 8:24 - 8:28
    by comparing a patient's health profile
  • 8:28 - 8:31
    to the average health profile
    of a reference population.
  • 8:31 - 8:35
    Longitudinal data would
    open up a new dimension
  • 8:35 - 8:37
    and allow abnormalities to be detected
  • 8:37 - 8:41
    based on a patient's own medical history.
  • 8:41 - 8:45
    This will pave the way
    for personalized treatment.
  • 8:45 - 8:47
    Sounds pretty great, right?
  • 8:47 - 8:49
    Now you will certainly have a question
  • 8:49 - 8:51
    that is something like,
  • 8:51 - 8:56
    "If the technology is as great as he says,
    then why aren't they using it today?"
  • 8:56 - 8:58
    And the only answer I can give you is,
  • 8:58 - 9:01
    not everything is as easy as it sounds.
  • 9:01 - 9:03
    There are technical challenges.
  • 9:03 - 9:08
    For example, there's the need
    for extremely reliable sensors
  • 9:08 - 9:11
    that can detect mixtures
    of volatile organic compounds
  • 9:11 - 9:14
    with sufficient reproducibility.
  • 9:14 - 9:16
    And another technical challenge is,
  • 9:16 - 9:21
    how do you sample a person's breath
    in a very defined manner
  • 9:21 - 9:24
    so that the sampling process itself
  • 9:24 - 9:27
    does not alter the result of the analysis?
  • 9:27 - 9:30
    And there's the need for data.
  • 9:30 - 9:34
    Breath analysis needs
    to be validated in clinical trials,
  • 9:34 - 9:36
    and enough data needs to be collected
  • 9:36 - 9:42
    so that individual conditions
  • 9:42 - 9:45
    can be measured against baselines.
  • 9:45 - 9:46
    Breath analysis can only succeed
  • 9:46 - 9:47
    if a large enough dataset can be generated
  • 9:47 - 9:51
    and made available for broad use.
  • 9:51 - 9:55
    If breath analysis
    holds up to its promises,
  • 9:55 - 9:58
    this is a technology
    that could truly aid us
  • 9:58 - 10:00
    to transform our health care system,
  • 10:00 - 10:04
    transform it from a reactive system
  • 10:04 - 10:07
    that treatment is triggered
    by symptoms of disease
  • 10:07 - 10:09
    to a proactive system
  • 10:09 - 10:12
    where disease detection,
    diagnosis and treatment
  • 10:12 - 10:14
    can happen at early stage,
  • 10:14 - 10:18
    way before any symptoms occur.
  • 10:18 - 10:20
    Now this brings me to my last point,
    and it's a fundamental one.
  • 10:20 - 10:25
    What exactly is a disease?
  • 10:25 - 10:29
    Imagine that breath analysis
    can be commercialized as I describe it
  • 10:29 - 10:32
    and early detection becomes routine.
  • 10:33 - 10:34
    A problem that remains
  • 10:34 - 10:38
    is in fact a problem that
    any screening activity has to face,
  • 10:38 - 10:40
    because for many diseases,
  • 10:40 - 10:44
    it is often impossible to predict
    with sufficient certainty
  • 10:44 - 10:47
    whether the disease
    would ever cause any symptoms
  • 10:47 - 10:49
    or put a person's life at risk.
  • 10:49 - 10:52
    This is called overdiagnosis,
  • 10:52 - 10:54
    and it leads to a dilemma.
  • 10:54 - 10:56
    If a disease is identified,
  • 10:56 - 10:58
    you could decide not to treat it
  • 10:58 - 11:03
    because there's a certain probability
    that you would never suffer from it.
  • 11:03 - 11:05
    But how much would you suffer
  • 11:05 - 11:08
    just from knowing that you have
    a potentially deadly disease?
  • 11:08 - 11:12
    And wouldn't you actually regret that the
    disease was detected in the first place?
  • 11:14 - 11:17
    Your second option
    is to undergo early treatment
  • 11:17 - 11:19
    with the hope for curing it,
  • 11:19 - 11:23
    but often this would not
    come without side effects.
  • 11:24 - 11:28
    To be precise,
  • 11:28 - 11:31
    the bigger problem is not overdiagnosis,
  • 11:31 - 11:32
    it's overtreatment,
  • 11:32 - 11:35
    because not every disease
    has to be treated immediately
  • 11:35 - 11:39
    just because a treatment is available.
  • 11:40 - 11:43
    The increasing adoption
    of routine screening
  • 11:43 - 11:45
    will raise the question:
  • 11:45 - 11:49
    what do we call a disease
    that can rationalize treatment,
  • 11:49 - 11:52
    and what is just an abnormality
    that should not be a source of concern?
  • 11:52 - 12:00
    My hopes are that routine screening
    using breath analysis
  • 12:00 - 12:03
    can provide enough data and insight
  • 12:03 - 12:08
    so that at some point,
    we'll be able to break this dilemma
  • 12:08 - 12:11
    and predict with sufficient certainty
  • 12:11 - 12:15
    whether and when to treat at early stage.
  • 12:15 - 12:19
    Our breath, and the mixture
    of volatile organic compounds
  • 12:19 - 12:20
    that we exhale,
  • 12:20 - 12:25
    hold tremendous amounts of information
    on our physiological condition.
  • 12:26 - 12:30
    With what we know today,
    we have only scratched the surface.
  • 12:30 - 12:35
    As we collect more and more data
    and breath profiles across the population,
  • 12:35 - 12:39
    including all varieties of gender,
    age, origin and lifestyle,
  • 12:39 - 12:42
    the power of breath analysis
    should increase,
  • 12:42 - 12:48
    and eventually breath analysis
    should provide us with a powerful tool
  • 12:48 - 12:52
    not only to proactively detect
    specific diseases
  • 12:52 - 12:57
    but to predict and
    ultimately prevent them,
  • 12:57 - 13:01
    and this should be enough
    motivation to embrace
  • 13:01 - 13:04
    the opportunities and challenges
  • 13:04 - 13:07
    that breath analysis can provide,
  • 13:07 - 13:10
    even for people that are not
    part-time hypochondriacs like me.
  • 13:10 - 13:13
    Thank you.
  • 13:13 - 13:17
    (Applause)
Title:
What your breath could reveal about your health
Speaker:
Julian Burschka
Description:

more » « less
Video Language:
English
Team:
closed TED
Project:
TEDTalks
Duration:
13:29

English subtitles

Revisions Compare revisions