April 25, 2021

Metabolic analysis brings to light ignored lung disease

Learn how occupational therapist, Jason was able to uncover and treat a case of Sarcoidosis using the PNOĒ device.

Breath analysis is a method able to analyze how well your heart, lungs, cells, and blood circulation are working individually but also in unison. This is achieved by analyzing 12 biomarkers in the human breath that reveal how effectively oxygen (O2) and carbon dioxide (CO2) are transported through each of the four systems. Figure 1 below provides an overview of the integrative nature of these four systems and how they work together to enable the flow of O2 and CO2 throughout the body. 

Figure 1 Flow of oxygen and carbon dioxide through the human body.

What is Sarcoidosis  

Sarcoidosis is a disease that results from the development of inflammatory cells (AKA granulomas). They may appear in any part of your body but are most commonly found in the lungs and lymph nodes. Other areas where they may appear include eyes, skin, heart, and other organs.

Although the root cause of sarcoidosis is unknown, medical doctors think it is typically a result of the body's immune system responding to certain substances. Research has shown that such substances include infectious agents, chemicals, or particulate matter. It is postulated that abnormal reactions to the body's own proteins may also be responsible for the formation of granulomas in people with specific genetic predispositions [1].

In this case, the patient’s background justified the presence of sarcoidosis. The 50-year-old had been a firefighter for decades and throughout his career had been exposed to chemicals and particulate matter in several instances. As a matter of fact, the individual had already been diagnosed with sarcoidosis but as in the case of most people suffering from the disease, he had grown accustomed and learned how to live with it without realizing the limitations it was posing to his job and quality of life.  

How PNOĒ identified the presence of Sarcoidosis

The 50-year old patient undertook the PNOĒ test which immediately revealed the presence of a lung limitation. Specifically, based on the test results, the individual wasn’t able to effectively transfer oxygen from the lungs into the bloodstream, a phenomenon denoting that Sarcoidosis was starting to affect his lungs’ performance by obstructing their ability to off-load O2 into the bloodstream to be delivered to the working muscle and organs.

Figure 2 shows the 50-year old breath analysis test with PNOE which shows:

  1. Low VO2peak (i.e. peak oxygen uptake) indicating an overall inability of the body to absorb oxygen

  2. A low VO2/BF (i.e. oxygen consumption per breathing cycle) ratio indicating impaired ability to maintain or increase oxygen uptake as breathing frequency increases

  3. A low SmO2 (i.e. muscle oxygen saturation) indicating low oxygen delivery to the working muscle

Figure 2 showing VOpeak (blue line), SmO2 (green line), VO2/BF (brown line)

The combination of the above indicates the presence of lung limitation preventing oxygen from entering the bloodstream from the lungs. Specifically, low VO2peak shows the presence of a limitation in the person’s body, low VO2/BF focuses the attention on the lungs whereas low SmO2 indicates that the limitation abstracts the delivery of O2 from the lungs to the bloodstream.

His lungs’ inability to effectively transfer O2 into the bloodstream also explained an observation of the 50-year old that he was burning through his O2 tank much faster than his fellow firefighters. Since his lungs weren’t transferring O2 effectively to the bloodstream, only a small portion of the O2 inhaled from the tank was absorbed with the majority being exhaled without being used.  

How a breathing problem resulted in a fat-burning problem

Fat is a molecule that requires O2 to be burnt and release the energy it contains. As such, a problem in the heart, lungs, or bloodstream that restricts O2 supply to the cells will immediately reduce a person’s ability to use fat as a fuel source. This phenomenon was also apparent in the case of the patient at hand. 

Figure 3 shows the evolution of the patient’s fat and carbohydrate burn as exercise intensity increase during the graded exercise test. Every person will experience higher fat burn during the initial stages of the test. Subsequently, as exercise intensity increases fat burn diminished, and carbohydrate burn increases. That’s because fat is a fuel source that burns slower than carbohydrates and is therefore unable to cover high rates of energy demand when exercise intensity is high.  

Figure 3 indicating fat (dark gree) and carbohydrate (turquoase) burn evolving as heart rate (light green) increases.

Individuals with impaired fat-burning ability will experience deterioration in their fat burn early on during the graded exercise test with the so-called crossover point (i.e. the point where carbohydrates become the predominant fuel source) occurring in relatively low exercise intensities. That was also the case with the patient at hand who achieved his crossover at 98 beats per minute which corresponds to only 58% of his maximum heart rate.  

Prescribing treatment 

Respiratory training is a very valuable intervention that can alleviate several lung-related problems. In this case, respiratory training proved to be a critical part of the patient’s training program and included pulmonary capacity and capability training. 

  • Capacity training includes the use of breathing resistance to increase the total available lung volume, in other words, the “usable” volume of a person’s lungs.

  • Capability training includes working out at specific breathing zones to increase the ability of available lung volumes to absorb oxygen. 

You can watch the full interview with Jason Lomond and PNOE’s head of science and education Daniel Crumback at the following link: https://www.youtube.com/watch?v=N4oNRwg9WvY


  1. Mayo Clinic Review - Sarcoidosis: https://www.mayoclinic.org/diseases-conditions/sarcoidosis/symptoms-causes/syc-20350358

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