{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T23:01:30Z","timestamp":1783033290568,"version":"3.54.6"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001003","name":"Boehringer Ingelheim","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001003","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Fibrotic interstitial lung diseases (fILDs) are a heterogeneous group of rare lung diseases. Symptoms of ILD are nonspecific, and diagnosis requires multiple investigations, including invasive procedures. Therefore, diagnostic delay is common. Previous single-center studies showed that profiling of exhaled volatile organic compounds using noninvasive electronic nose (eNose) sensor technology has potential as a diagnostic tool for ILD. We aimed to validate eNose technology to differentiate various ILDs in an international multicenter cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included patients with an ILD diagnosis established in a multidisciplinary team (MDT) discussion and pulmonary fibrosis on high-resolution chest computed tomography scans at 5 international ILD expert centers. An eNose (SpiroNose) was used for exhaled breath analysis. We compared eNose breath profiles of different ILD subtypes with all other ILDs combined and across 6 different ILD subtypes. Breath profiles were analyzed with partial least squares discriminant and receiver operating characteristic analyses. Models were trained on data from a selection of centers and externally validated in other centers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Breath profiles of 587 patients were analyzed. Comparing breath profiles of ILD subtypes with all other ILDs resulted in area under the curve (AUC) values ranging from 0.88 to 0.92 in the training set and 0.75 to 0.95 in the validation set. The ILD subtypes could be discriminated with AUCs ranging from 0.95 to 0.98 in the training set and 0.83 to 0.93 in the validation set.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This international study demonstrates that eNose technology accurately differentiates breath profiles from \u00adpatients with various ILDs. eNose technology holds potential as an easy point-of-care tool for the diagnosis of fILDs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajrccm\/aamaf085","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T12:20:00Z","timestamp":1767615600000},"page":"981-988","source":"Crossref","is-referenced-by-count":2,"title":["International validation of electronic nose technology as a diagnostic tool for fibrotic interstitial lung diseases"],"prefix":"10.1093","volume":"212","author":[{"given":"Bart J","family":"Formsma","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Center of Excellence for ILD and Sarcoidosis, Erasmus University Medical Center , Rotterdam,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris G","family":"Van Der Sar","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Center of Excellence for ILD and Sarcoidosis, Erasmus University Medical Center , Rotterdam,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leda","family":"Yazbeck","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, The Royal Brompton and Harefield Hospitals, Guy\u2019s and St Thomas\u2019s NHS Foundation Trust , London,","place":["United Kingdom"]},{"name":"National Heart and Lung Institute, Imperial College London Department of Respiratory Medicine, , London,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kreuter","sequence":"additional","affiliation":[{"name":"Department of Pneumology, Mainz Center for Pulmonary Medicine, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine , Mainz,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5591-0955","authenticated-orcid":false,"given":"Vincent","family":"Cottin","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, ERN-LUNG, UMR 754, INRAE, Claude Bernard University Lyon 1 , Lyon,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Polke","sequence":"additional","affiliation":[{"name":"Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg , Heidelberg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamera J","family":"Corte","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital , Sydney,","place":["Australia"]},{"name":"Faculty of Medicine and Health, University of Sydney , Sydney,","place":["Australia"]},{"name":"Centre of Research Excellence in Pulmonary Fibrosis ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mymy","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital , Sydney,","place":["Australia"]},{"name":"Faculty of Medicine and Health, University of Sydney , Sydney,","place":["Australia"]},{"name":"Centre of Research Excellence in Pulmonary Fibrosis ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip L","family":"Molyneaux","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, The Royal Brompton and Harefield Hospitals, Guy\u2019s and St Thomas\u2019s NHS Foundation Trust , London,","place":["United Kingdom"]},{"name":"National Heart and Lung Institute, Imperial College London Department of Respiratory Medicine, , London,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5295-2877","authenticated-orcid":false,"given":"Catharina C","family":"Moor","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Center of Excellence for ILD and Sarcoidosis, Erasmus University Medical Center , Rotterdam,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4527-6962","authenticated-orcid":false,"given":"Marlies S","family":"Wijsenbeek","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Center of Excellence for ILD and Sarcoidosis, Erasmus University Medical Center , Rotterdam,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"2026051218211479600_aamaf085-B1","doi-asserted-by":"publisher","first-page":"e18","DOI":"10.1164\/rccm.202202-0399ST","article-title":"Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS\/ERS\/JRS\/ALAT clinical practice guideline","volume":"205","author":"Raghu","year":"2022","journal-title":"Am J Respir Crit Care Med"},{"key":"2026051218211479600_aamaf085-B2","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1016\/S0140-6736(22)01052-2","article-title":"Interstitial lung diseases","volume":"400","author":"Wijsenbeek","year":"2022","journal-title":"Lancet"},{"key":"2026051218211479600_aamaf085-B3","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1186\/s12890-021-01783-1","article-title":"Efficacy of antifibrotic drugs, nintedanib and pirfenidone, in treatment of progressive pulmonary fibrosis in both \u00adidiopathic pulmonary fibrosis (IPF) and non-IPF: a systematic review and meta-analysis","volume":"21","author":"Finnerty","year":"2021","journal-title":"BMC Pulm Med"},{"key":"2026051218211479600_aamaf085-B4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2022-001276","article-title":"Diagnostic delay in IPF impacts progression-free survival, quality of life and hospitalisation rates","volume":"9","author":"Hoyer","year":"2022","journal-title":"BMJ Open Respir Res"},{"key":"2026051218211479600_aamaf085-B5","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1016\/S2213-2600(21)00017-5","article-title":"Early diagnosis of \u00adfibrotic interstitial lung disease: challenges and opportunities","volume":"9","author":"Spagnolo","year":"2021","journal-title":"Lancet Respir Med"},{"key":"2026051218211479600_aamaf085-B6","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1164\/rccm.202401-0048PP","article-title":"The role of inflammation and fibrosis in interstitial lung disease treatment decisions","volume":"210","author":"Behr","year":"2024","journal-title":"Am J Respir Crit Care Med"},{"key":"2026051218211479600_aamaf085-B7","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1186\/s12931-021-01835-4","article-title":"The smell of lung disease: a review of the current status of electronic nose technology","volume":"22","author":"van der Sar","year":"2021","journal-title":"Respir Res"},{"key":"2026051218211479600_aamaf085-B8","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1378\/chest.14-0781","article-title":"Breathomics in lung disease","volume":"147","author":"van der Schee","year":"2015","journal-title":"Chest"},{"key":"2026051218211479600_aamaf085-B9","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02042-2020","article-title":"Exhaled breath analysis by use of eNose technology: a novel diagnostic tool for interstitial lung disease","volume":"57;","author":"Moor","year":"2021","journal-title":"Eur Respir J"},{"key":"2026051218211479600_aamaf085-B10","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1016\/j.chest.2021.10.025","article-title":"Diagnostic performance of electronic nose technology in sarcoidosis","volume":"161","author":"van der Sar","year":"2022","journal-title":"Chest"},{"key":"2026051218211479600_aamaf085-B11","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1186\/s12931-023-02575-3","article-title":"Differentiating interstitial lung diseases from other respiratory diseases using electronic nose technology","volume":"24","author":"van der Sar","year":"2023","journal-title":"Respir Res"},{"key":"2026051218211479600_aamaf085-B12","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1183\/13993003.00150-2015","article-title":"An official European Respiratory Society\/American Thoracic Society research statement: interstitial pneumonia with autoimmune features","volume":"46","author":"Fischer","year":"2015","journal-title":"Eur Respir J"},{"key":"2026051218211479600_aamaf085-B13","doi-asserted-by":"publisher","first-page":"046001","DOI":"10.1088\/1752-7155\/9\/4\/046001","article-title":"Integration of electronic nose technology with spirometry: validation of a new approach for exhaled breath analysis","volume":"9","author":"de Vries","year":"2015","journal-title":"J Breath Res"},{"key":"2026051218211479600_aamaf085-B14","doi-asserted-by":"publisher","first-page":"1701817","DOI":"10.1183\/13993003.01817-2017","article-title":"Clinical and inflammatory phenotyping by breathomics in chronic airway diseases irrespective of the diagnostic label","volume":"51","author":"de Vries","year":"2018","journal-title":"Eur Respir J"},{"key":"2026051218211479600_aamaf085-B15","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8101698","article-title":"Exploring the ability of electronic nose technology to recognize interstitial lung diseases (ILD) by non-invasive breath screening of exhaled Volatile Compounds (VOC): a pilot study from the European IPF Registry (eurIPFreg) and biobank","volume":"8","author":"Krauss","year":"2019","journal-title":"J Clin Med"},{"key":"2026051218211479600_aamaf085-B16","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1016\/j.rmed.2013.03.011","article-title":"An electronic nose discriminates exhaled breath of patients with untreated pulmonary sarcoidosis from controls","volume":"107","author":"Dragonieri","year":"2013","journal-title":"Respir Med"},{"key":"2026051218211479600_aamaf085-B17","doi-asserted-by":"publisher","first-page":"047101","DOI":"10.1088\/1752-7163\/ab8c2e","article-title":"Exhaled volatile organic compounds analysis by e-nose can detect idiopathic pulmonary fibrosis","volume":"14","author":"Dragonieri","year":"2020","journal-title":"J Breath Res"},{"key":"2026051218211479600_aamaf085-B18","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/S2213-2600(13)70191-7","article-title":"Chronic hypersensitivity pneumonitis in patients diagnosed with idiopathic pulmonary fibrosis: a prospective case-cohort study","volume":"1","author":"Morell","year":"2013","journal-title":"Lancet Respir Med"},{"key":"2026051218211479600_aamaf085-B19","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1016\/S2213-2600(16)30033-9","article-title":"Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study","volume":"4","author":"Walsh","year":"2016","journal-title":"Lancet Respir Med"},{"key":"2026051218211479600_aamaf085-B20","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1164\/rccm.202309-1692OC","article-title":"Machine learning of plasma proteomics classifies diagnosis of interstitial lung disease","volume":"210","author":"Huang","year":"2024","journal-title":"Am J Respir Crit Care Med"},{"key":"2026051218211479600_aamaf085-B21","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1164\/rccm.202404-0748LE","article-title":"Classifying interstitial lung disease: omics are in the air","volume":"210","author":"van der Sar","year":"2024","journal-title":"Am J Respir Crit Care Med"},{"key":"2026051218211479600_aamaf085-B22","doi-asserted-by":"publisher","first-page":"230055","DOI":"10.1183\/16000617.0055-2023","article-title":"Towards the adoption of quantitative computed tomography in the management of interstitial lung disease","volume":"33","author":"Walsh","year":"2024","journal-title":"Eur Respir Rev"},{"key":"2026051218211479600_aamaf085-B23","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/j.chest.2022.09.042","article-title":"Diagnosing non-small cell lung cancer by exhaled breath profiling using an electronic nose: a multicenter validation study","volume":"163","author":"Kort","year":"2023","journal-title":"Chest"},{"key":"2026051218211479600_aamaf085-B24","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.annonc.2025.03.013","article-title":"Lung cancer detection by electronic nose analysis of exhaled breath: a multi-center prospective external validation study","volume":"36","author":"Buma","year":"2025","journal-title":"Ann Oncol"},{"key":"2026051218211479600_aamaf085-B25","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.1164\/rccm.200906-0939OC","article-title":"Exhaled breath profiling enables discrimination of chronic obstructive pulmonary disease and asthma","volume":"180","author":"Fens","year":"2009","journal-title":"Am J Respir Crit Care Med"},{"key":"2026051218211479600_aamaf085-B26","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1111\/j.1365-2222.2011.03800.x","article-title":"External validation of exhaled breath profiling using an electronic nose in the discrimination of asthma with fixed airways obstruction and chronic obstructive pulmonary disease","volume":"41","author":"Fens","year":"2011","journal-title":"Clin Exp Allergy"},{"key":"2026051218211479600_aamaf085-B27","doi-asserted-by":"publisher","first-page":"220003","DOI":"10.1183\/16000617.0003-2022","article-title":"Multidisciplinary teams in the clinical care of fibrotic interstitial lung disease: current perspectives","volume":"31","author":"Cottin","year":"2022","journal-title":"Eur Respir Rev"}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/advance-article-pdf\/doi\/10.1093\/ajrccm\/aamaf085\/66518981\/aamaf085.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/212\/5\/981\/66518981\/aamaf085.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/212\/5\/981\/66518981\/aamaf085.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T22:21:18Z","timestamp":1778624478000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/212\/5\/981\/8435556"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":27,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,1,23]]},"published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ajrccm\/aamaf085","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,1,23]]}}}