Choosing the Right Breath Testing Instrumentation

Choosing the Right BreathTracker™

The correct choice of BreathTracker for a laboratory or office should be made on the basis of the individual laboratory/office. Considerations should include the kind of practice engaged in by the physicians and the expected number of patients which will need breath-tests. The CLIA regulations have exempted breath-testing from their certification for now (since 1996), so the test can be done in a laboratory or office not certified by the HHS.

Additional information on the BreathTrackers is located in the “Instrumentation” section.

Selecting and Instrument for H2 Analysis Only

If the customer selects an instrument only for the measurement of H2 (usually based on an expected low workload or for a specific research application), a choice can be made between the BreathTracker H2 or BreathTracker H2+ (Plus). These less expensive BreathTrackers will detect hydrogen (H2) as well as the other QuinTron analyzers, but they will allow a small percentage of lactose malabsorbers to avoid detection due to conversion of H2 to Methane (CH4). This principle is not limited to only QuinTron instrumentation, all other manufacturer analyzers which are limited to only H2 analysis also have this limitation.

The main difference between the BreathTracker H2 and H2+ model is the additional CO2 sensor installed into the BreathTracker H2+. The BreathTracker H2 and H2+ models were designed as clinical instruments and are recommended only if cost is the determining factor. The BreathTracker H2 can be as accurate and reliable as the other instruments if attention is paid to its analytical technique, and if it is operated properly.

Why CH4 Analysis Should be Included in the Test

Two models are available for the measurement of H2 and CH4; the BreathTracker DP and BreathTracker SC.

As described earlier above, some malabsorbers who have negative H2 breath-tests may generate CH4 instead. These patients will be recognized if CH4 is measured as part of the routine test. If the malabsorber generates neither H2 nor CH4 following ingestion of a nonabsorbed sugar, the patient must be a “non-producer”, either as a result of having a sterile gut or of having rapid-transit diarrhea and/or a hostile pH (acidity too severe for the existence of hydrogen-producing bacteria).

There is overwhelming evidence in field-literature that most patients who fail to produce significant increases in H2 after the administration of lactulose excrete increased levels of CH4. In one study a linear relationship was found between the amount of a disaccharide mixture ingested and H2 produced over a 10-hour period. If CH4 was formed, the sum of both gases followed a linear dose-effect relationship, indicating an interaction between the two components. Others have demonstrated an effect of CH4-production on fasting H2 baseline values, breath-H2 area under the curve following lactulose and orocecal transit time, suggesting that knowledge of CH4 status is necessary for the proper interpretation of the H2 breath-test.

The BreathTracker DP has the same H2 analysis specifications and features as the BreathTracker H2 and H2+ models, with the additional feature of detecting CH4 in the same alveolar air sample.

The BreathTracker SC, analyzer of choice for breath trace-gas studies, measures H2 and CH4, and uses carbon dioxide (CO2) to correct for any dilution of the alveolar sample by dead space air or sampling error.

Why CO2 Measurements Should be Utilized

The BreathTracker SC and H2+ models have a unique feature for detecting and correcting samples for contamination with room air or dead space air during the collection procedure. Such contaminations result from improper sample collection, in which some of the respiratory dead space air is captured with the sample, or the technician inadvertently contaminates the sample with room air during handling. These two BreathTracker models measure the CO2 in the sample, then compare it with what the alveolar CO2 should be, and corrects each samples H2 and/or CH4 values for the contamination.