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The Peppermint Initiative, established within the International Association of Breath Research, introduced the peppermint protocol, a breath analysis benchmarking effort designed to address the lack of inter-comparability of outcomes across different breath sampling techniques and analytical platforms. Benchmarking with gas chromatography-ion mobility spectrometry (GC-IMS) using peppermint has been previously reported however, coupling micro-thermal desorption ( µ TD) to GC-IMS has not yet, been benchmarked for breath analysis. To benchmark µ TD-GC-IMS for breath analysis using the peppermint protocol. Ten healthy participants (4 males and 6 females, aged 20-73 years), were enrolled to give six breath samples into Nalophan bags via a modified peppermint protocol. Breath sampling after peppermint ingestion occurred over 6 h at t = 60, 120, 200, 280, and 360 min. The breath samples (120 cm 3 ) were pre-concentrated in the µ TD before being transferred into the GC-IMS for detection. Data was processed using VOCal, including background subtractions, peak volume measurements, and room air assessment. During peppermint washout, eucalyptol showed the highest change in concentration levels, followed by α -pinene and β -pinene. The reproducibility of the technique for breath analysis was demonstrated by constructing logarithmic washout curves, with the average linearity coefficient of R 2 = 0.99. The time to baseline (benchmark) value for the eucalyptol washout was 1111 min (95% CI: 529-1693 min), obtained by extrapolating the average logarithmic washout curve. The study demonstrated that µ TD-GC-IMS is reproducible and suitable technique for breath analysis, with benchmark values for eucalyptol comparable to the gold standard GC-MS., (Creative Commons Attribution license.)

Background: From a public health perspective, the identification of individuals with mild respiratory symptoms due to SARS-CoV-2 infection is important to contain the spread of the disease. The objective of this study was to identify volatile organic compounds (VOCs) in exhaled breath common to infection with different variants of the SARS-CoV-2 virus to inform the development of a point-of-care breath test to detect infected individuals with mild symptoms., Methods: A prospective, real-world, observational study was conducted on mildly symptomatic out-patients presenting to community test-sites for RT-qPCR SARS-CoV-2 testing when the Alpha, Beta, and Delta variants were driving the COVID-19 pandemic. VOCs in exhaled breath were compared between PCR-positive and negative individuals using TD-GC-ToF-MS. Candidate VOCs were tested in an independent set of samples collected during the Omicron phase of the pandemic., Findings: Fifty breath samples from symptomatic RT-qPCR positive and 58 breath samples from test-negative, but symptomatic participants were compared. Of the 50 RT-qPCR-positive participants, 22 had breath sampling repeated 8-12 weeks later. PCA-X model yielded 12 distinct VOCs that discriminated SARS-CoV-2 active infection compared to recovery/convalescence period, with an area under the receiver operator characteristic curve (AUROC), of 0.862 (0.747-0.977), sensitivity, and specificity of 82% and 86%, respectively. PCA-X model from 50 RT-qPCR positive and 58 negative symptomatic participants, yielded 11 VOCs, with AUROC of 0.72 (0.604-0.803) and sensitivity of 72%, specificity 65.5%. The 11 VOCs were validated in a separate group of SARS-CoV-2 Omicron positive patients' vs healthy controls demonstrating an AUROC of 0.96 (95% CI 0.827-0.993) with sensitivity of 80% specificity of 90%., Interpretation: Exhaled breath analysis is a promising non-invasive, point-of-care method to detect mild COVID-19 infection., Funding: Funding for this study was a competitive grant awarded from the Vancouver Coastal Research Institute as well as funding from the BC Cancer Foundation., Competing Interests: Declaration of interests The authors have no conflict of interest., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

The Peppermint Initiative seeks to inform the standardisation of breath analysis methods. Five Peppermint Experiments with gas chromatography-ion mobility spectrometry (GC-IMS), operating in the positive mode with a tritium 3 H 5.68 keV, 370 MBq ionisation source, were undertaken to provide benchmark Peppermint Washout data for this technique, to support its use in breath-testing, analysis, and research. Headspace analysis of a peppermint-oil capsule by GC-IMS with on-column injection (0.5 cm 3 ) identified 12 IMS responsive compounds, of which the four most abundant were: eucalyptol; β -pinene; α -pinene; and limonene. Elevated concentrations of these four compounds were identified in exhaled-breath following ingestion of a peppermint-oil capsule. An unidentified compound attributed as a volatile catabolite of peppermint-oil was also observed. The most intense exhaled peppermint-oil component was eucalyptol, which was selected as a peppermint marker for benchmarking GC-IMS. Twenty-five washout experiments monitored levels of exhaled eucalyptol, by GC-IMS with on-column injection (0.5 cm 3 ), at t = 0 min, and then at t + 60, t + 90, t + 165, t + 285 and t + 360 min from ingestion of a peppermint capsule resulting in 148 peppermint breath analyses. Additionally, the Peppermint Washout data was used to evaluate clinical deployments with a further five washout tests run in clinical settings generating an additional 35 breath samples. Regression analysis yielded an average extrapolated time taken for exhaled eucalyptol levels to return to baseline values to be 429 ± 62 min (±95% confidence-interval). The benchmark value was assigned to the lower 95% confidence-interval, 367 min. Further evaluation of the data indicated that the maximum number of volatile organic compounds discernible from a 0.5 cm 3 breath sample was 69, while the use of an in-line biofilter appeared to reduce this to 34., (Creative Commons Attribution license.)

Background: There is an urgent need to rapidly distinguish COVID-19 from other respiratory conditions, including influenza, at first-presentation. Point-of-care tests not requiring laboratory- support will speed diagnosis and protect health-care staff. We studied the feasibility of using breath-analysis to distinguish these conditions with near-patient gas chromatography-ion mobility spectrometry (GC-IMS)., Methods: Independent observational prevalence studies at Edinburgh, UK, and Dortmund, Germany, recruited adult patients with possible COVID-19 at hospital presentation. Participants gave a single breath-sample for VOC analysis by GC-IMS. COVID-19 infection was identified by transcription polymerase chain reaction (RT- qPCR) of oral/nasal swabs together with clinical-review. Following correction for environmental contaminants, potential COVID-19 breath-biomarkers were identified by multi-variate analysis and comparison to GC-IMS databases. A COVID-19 breath-score based on the relative abundance of a panel of volatile organic compounds was proposed and tested against the cohort data., Findings: Ninety-eight patients were recruited, of whom 21/33 (63.6%) and 10/65 (15.4%) had COVID-19 in Edinburgh and Dortmund, respectively. Other diagnoses included asthma, COPD, bacterial pneumonia, and cardiac conditions. Multivariate analysis identified aldehydes (ethanal, octanal), ketones (acetone, butanone), and methanol that discriminated COVID-19 from other conditions. An unidentified-feature with significant predictive power for severity/death was isolated in Edinburgh, while heptanal was identified in Dortmund. Differentiation of patients with definite diagnosis (25 and 65) of COVID-19 from non-COVID-19 was possible with 80% and 81.5% accuracy in Edinburgh and Dortmund respectively (sensitivity/specificity 82.4%/75%; area-under-the-receiver- operator-characteristic [AUROC] 0.87 95% CI 0.67 to 1) and Dortmund (sensitivity / specificity 90%/80%; AUROC 0.91 95% CI 0.87 to 1)., Interpretation: These two studies independently indicate that patients with COVID-19 can be rapidly distinguished from patients with other conditions at first healthcare contact. The identity of the marker compounds is consistent with COVID-19 derangement of breath-biochemistry by ketosis, gastrointestinal effects, and inflammatory processes. Development and validation of this approach may allow rapid diagnosis of COVID-19 in the coming endemic flu seasons., Funding: MR was supported by an NHS Research Scotland Career Researcher Clinician award. DMR was supported by the University of Edinburgh ref COV_29., Competing Interests: DMR and CLPT report a grant from University of Edinburgh. TW reports personal fees from G.A.S. Gesellschaft für analytische Sensorsysteme mbH,  outside the submitted work;  In addition, Dr. Wortelmann has a patent PCT/EP2014/075236 pending.Dr. Wortelmann reports personal fees from G.A.S. Gesellschaft für analytische Sensorsysteme mbH,  outside the submitted work;  In addition, Dr. Wortelmann has a patent PCT/EP2014/075236 pending, (© 2020 The Authors.)

Sampling of volatile organic compounds (VOCs) has shown promise for detection of a range of diseases but results have proved hard to replicate due to a lack of standardization. In this work we introduce the 'Peppermint Initiative'. The initiative seeks to disseminate a standardized experiment that allows comparison of breath sampling and data analysis methods. Further, it seeks to share a set of benchmark values for the measurement of VOCs in breath. Pilot data are presented to illustrate the standardized approach to the interpretation of results obtained from the Peppermint experiment. This pilot study was conducted to determine the washout profile of peppermint compounds in breath, identify appropriate sampling time points, and formalise the data analysis. Five and ten participants were recruited to undertake a standardized intervention by ingesting a peppermint oil capsule that engenders a predictable and controlled change in the VOC profile in exhaled breath. After collecting a pre-ingestion breath sample, five further samples are taken at 2, 4, 6, 8, and 10 h after ingestion. Samples were analysed using ion mobility spectrometry coupled to multi-capillary column and thermal desorption gas chromatography mass spectrometry. A regression analysis of the washout data was used to determine sampling times for the final peppermint protocol, and the time for the compound measurement to return to baseline levels was selected as a benchmark value. A measure of the quality of the data generated from a given technique is proposed by comparing data fidelity. This study protocol has been used for all subsequent measurements by the Peppermint Consortium (16 partners from seven countries). So far 1200 breath samples from 200 participants using a range of sampling and analytical techniques have been collected. The data from the consortium will be disseminated in subsequent technical notes focussing on results from individual platforms.

Compact mass spectrometry (CMS) is a versatile and transportable analytical instrument that has the potential to be used in clinical settings to quickly and non-invasively detect a wide range of relevant conditions from breath samples. The purpose of this study is to optimise data preprocessing protocols by three proposed methods of breath sampling, using the CMS. It also lays out a general framework for which data processing methods can be evaluated., Methods: This paper considers data from three previous studies, each using a different breath sampling method. These include a peppermint washout study using continuous breath sampling with a purified air source, an exercise study using continuous breath sampling with an ambient air source, and a single breath sampling study with an ambient air source. For each dataset, different breath selection (data preprocessing) methods were compared and benchmarked according to predictive performance on a validation set and quantitative reliability of m/z bin intensity measurements., Results: For both continuous methods, the best breath selection method improved the predictive model compared to no preselection, as measured by the 95% CI range for Youden's index, from 0.68-0.86 to 0.86-0.97 for the exercise study and 0.69-0.82 to 1.00-1.00 for the peppermint study. The reliability of intensity measurements for both datasets (as measured by median relative standard deviation (RSD)), was improved slightly by the best selection method compared to no preselection, from 18% to 14% for the exercise study and 7%-5% for the peppermint study. For the single breath samples, all the models resulted in perfect prediction, with a 95% CI range for Youden's index of 1.00-1.00. The reliability of the proposed method was 38%., Conclusion: The method of selecting exhaled breath from CMS data can affect the reliability of the measurement and the ability to distinguish between breath samples taken under different conditions. The application of appropriate data processing methods can improve the quality of the data and results obtained from CMS. The methods presented will enable untargeted analysis of breath VOCs using CMS to be performed.

Differential mobility spectrometry (DMS) is currently being used for environmental monitoring of space craft atmospheres and has been proposed for the rapid assessment of patients at accident and emergency receptions. Three studies investigated hitherto undescribed complexity in the DMS spectra of methanol, ethanol, propan-1-ol and butan-1-ol product ions formed from a (63)Ni ionisation source. 54 000 DMS spectra obtained over a concentration range of 0.01 mg m(-3)(g) to 1.80 g m(-3)(g) revealed the phenomenon of auto-modification of the product ions. This occurred when the neutral vapour concentration exceeded the level required to induce a neutral-ion collision during the low field portion of the dispersion field waveform. Further, post-ionisation cluster-ion formation or protonated monomer/proton bound dimer inter-conversion within the ion-filter was indicated by apparent shifts in the values of the protonated monomer compensation field maximum; indicative of post-ionisation conversion of the protonated monomer to a proton-bound dimer. APCI-DMS-quadrupole mass spectrometry studies enabled the ion dissociation products from dispersion-field heating to be monitored and product ion fragmentation relationships to be proposed. Methanol was not observed to dissociate, while propan-1-ol and butan-1-ol underwent dissociation reactions consistent with dehydration processes that led ultimately to the generation of what is tentatively assigned as a cyclo-C3H3(+) ion (m/z 39) and hydrated protons. Studies of the interaction of ion filter temperature with dispersion-field heating of product ions isolated dissociation/fragmentation product ions that have not been previously described in DMS. The implications of these combined findings with regard to data sharing and data interpretation were highlighted.

Aim: Breath analyses have potential to detect early signs of disease onset. Ambient ionization allows direct combination of breath gases with MS for fast, on-line analysis. Portable MS systems would facilitate field/clinic-based breath analyses. Results & methodology: Volunteers ingested peppermint oil capsules and exhaled volatile compounds were monitored over 10 h using a compact mass spectrometer. A rise and fall in exhaled menthone was observed, peaking at 60-120 min. Real-time analysis showed a gradual rise in exhaled menthone postingestion. Sensitivity was comparable to established methods, with detection in the parts per trillion range., Conclusion: Breath volatiles were readily analyzed on a portable mass spectrometer through a simple inlet modification. Induced changes in exhaled profiles were detectable with high sensitivity and measurable in real-time.

A polydimethylsiloxane oral sampler was used to extract methanol, ethanol, ethylene glycol, 1,3-propandiol and γ-hydroxybutyric acid from samples of human saliva obtained using a passive drool approach. The extracted compounds were recovered by thermal desorption, isolated by gas chromatography and detected with differential mobility spectrometry, operating with a programmed dispersion field. Complex signal behaviours were also observed that were consistent with hitherto unobserved fragmentation behaviours in differential mobility spectrometry. These yielded high-mobility fragments obscured within the envelope of the water-based reactant ion peak. Further, compensation field maxima shifts were also observed which were attributable to transport gas modification phenomena. Nevertheless, the responses obtained indicated that in vivo saliva sampling with thermal desorption gas chromatography may be used to provide a semi-quantitative diagnostic screen over the toxicity threshold concentration ranges of 100 mg dm(-3) to 3 g dm(-3). A candidate method suitable for use in low resource settings for the non-invasive screening of patients intoxicated by alcohols and volatile sedatives has been demonstrated.