Abstract:
A diagnosis method for respiratory disease based on the separation of the expired airway phase in an exhaled breath from the alveolar phase, and a device to accomplish the method. The device includes a cartridge assembly and a disposable condensing chamber carried in a substantially enclosed housing. The cartridge assembly includes a disposable cartridge and a reusable control system that monitors a characteristic of gas passing through the cartridge to determine when to divert the exhaled breath to an exhaust outlet and when to divert the exhaled breath to the condensing chamber. The characteristic is selected as being representative of the transition from the expired airway phase to the alveolar phase. Also included are a refrigeration system, an auxiliary monitoring system for determining when a sufficient volume of gas has been produced, and a built-in analyzer.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application is entitled to the benefit of, and claims priority to, provisional U.S. patent application Ser. No. 60/447,581 filed Feb. 14, 2003 and entitled “DEVICE AND METHOD FOR COLLECTION OF EXHALED ALVEOLAR BREATH CONDENSATE,” the entirety of which is incorporated herein by reference. 
    
    
     BACKGROUND OF THE PRESENT INVENTION 
     1. Field of the Present Invention 
     The present invention relates generally to breath condensate collection, and more particularly, to full-featured breath condensate collection apparatuses capable of separating the expired airway phase of mammalian exhalation from the alveolar phase. 
     2. Background 
     As is well known, exhaled breath condensate contains water-soluble and water insoluble molecules, including dissolved gases, organic solutes, ions and proteins. Analysis of the molecular content of breath condensate can provide a method to diagnose and prognose certain diseases. (S. A. Kharitonov and P. J. Barnes, Exhaled markers of pulmonary disease,  Am J Respir Crit Care Med  163:1693-1722, 2001.) However, the measurement of substances in exhaled condensate as a method to determine the presence of pathophysiologic processes in the lung alveoli is degraded by contamination by substances arising from the mouth, nose, throat and the tracheobronchial tree. Using two dimensional gel electrophoresis, Griese and colleagues demonstrated distinctly different proteins in breath condensate collected from oral breathing, compared with nasal breathing (M. Griese,  Proteomics  2:690-696, 2002.) This contamination can cause false positive testing. 
     It is our hypothesis that a gating mechanism can be triggered from the measurement of the partial pressure of carbon dioxide in exhaled breath to open and close during the exhalation cycle in a manner to separate out the contaminant breath volume, generated during the expired airway phase of the exhalation cycle, from the alveolar volume generated during the alveolar phase of the cycle. The ability to selectively collect alveolar breath condensate rapidly and easily with a point-of-care device would improve the clinical utility of breath-based diagnosis for this purpose, particularly in the emergency department or clinic setting. The device described is designed to allow a patient to breath into a handheld disposable chamber to facilitate the collection of breath water vapor which can then be analyzed for biochemicals to detect the presence of specific diseases, including bacterial, chlamydial, mycoplasma, or fungal pulmonary infection, pulmonary embolism, pulmonary ischemia, systemic gram negative sepsis, fat embolism from sickle cell disease or after surgical fixation of fractures, carcinoma of the lung, asthmatic inflammation, and chronic obstructive pulmonary disease. 
     Experimental History and Observations Leading to Conception of Invention 
     An experimental pulmonary vascular occlusion (PVO), induced by venous infusion of polystyrene microspheres in rats, has been used to determine three major findings related to the device of the present invention. Using anesthetized, tracheostomized mechanically ventilated rats, exhaled-breath condensate was collected in a pilot version of the present invention. The condensing chamber consisted of a sterile pipette within dry ice. As compared with control rats, increased concentrations of proteins, eicosinoid derivatives and peptides associated with fibrinolysis were found in the condensate of rats with PVO. (Nakos, Am J Resp Crit Care Med 1998, 158:1504.) The magnitude of the concentration of these vasoconstrictive agents correlated with the severity of hypoxemia and pulmonary hypertension in the subject rats. 
     A variety of methods and apparatuses have been proposed for use in breath analysis, but none accomplish the needs and benefits of the present invention. Several of these, including U.S. Pat. Nos. 6,033,368 and 6,419,634 to Gaston et al., U.S. Pat. No. 6,585,661 to Hunt et al., U.S. Publication No. 2003/0208132 A1 to Baddour, Eur. Patent No. 0,759,169 B1 to Winsel et al., and PCT Patent App. No. 02/082977 to Vaughan et al., disclose breath condensate collection devices, but each has significant shortcomings. First, no known apparatus includes the use of a monitoring system in a breath condensate collection device as a mechanism to trigger a valve open and shut during the exhalation cycle for the purpose of collecting only one type of condensate—i.e., alveolar condensate or expired airway condensate. The former type of condensate is especially important in the use of a breath collection device to diagnose lower tract pulmonary infection, as it is necessary to eliminate contamination of the breath sample from the nasopharyngeal flora. Similarly, the latter type of condensate is especially important in diagnosing upper tract infection. 
     Other devices or methods are known for separating the expired airway phase from the alveolar phase for such purposes as the detection of alcohol levels in a person&#39;s breath. For example, U.S. Pat. No. 3,613,665 to Gorsuch, U.S. Pat. No. 3,830,630 to Kiefer, U.S. Pat. No. 4,248,245 to Kempin, U.S. Pat. No. 5,327,901 to Delente, U.S. Pat. No. 5,376,555 to Forrester disclose methods and apparatuses for achieving such separation. Some, but not all, of these devices and methods use active mechanisms for providing such separation, while others use passive means. Unfortunately, all known devices and methods suffer drawbacks. For example, the Gorsuch device measures temperature with a heated thermistor and triggers a valve when the temperature differential indicates that the alveolar phase has been reached, while the Kempin device measures temperature differentials to determine when to divert exhaled breath into a measuring chamber. Temperature-based valve triggers may not be as reliable as desired. Neither the Kiefer device nor the methodology disclosed by Forrester is used to physically separate the alveolar phase breath from expired airway phase breath. Instead, the filament used in Kiefer is used merely to activate an alcohol-measuring section, while the Forrester methodology uses automated analysis of infrared profiles of the exhaled breath to identify the different phases thereof. Finally, the Delente device is passive, relying on a simple technique to retain in a collection chamber only the last portion of an exhaled breath, which is assumed to be alveolar phase rather than expired airway phase because it comes from the end of the exhaled breath. None of these devices or methods are thus suitable for use in breath condensate collection. 
     Moreover, none of the known devices or methods for separating the expired airway phase from the alveolar phase have been applied to breath condensate collection devices. In fact, some of the devices, such as the Kempin device, takes steps or include features specifically to avoid condensation because it interferes with the measurement of the gases themselves. Finally, although the Forrester methodology uses infrared analysis of exhaled breath, none of the devices or methods use spectrometry methods to determine when the alveolar phase of an exhaled breath has been reached and to trigger a valve creating physical separation of the alveolar phase from the expired airway phase. 
     A need exists for a specific condensation chamber designed to allow delivery of a sample of condensate to an analysis system that is separate from the machine in order to allow point-of-care immunoassay for certain antigens. In particular, a need exists for an immunoassay in the form of a small plastic cartridge, similar to a conventional home pregnancy test kit except that the antibodies in the matrix are directed against antigens that will help diagnose pulmonary embolism and pulmonary infection. Antibodies that will preferably be tested may include, but are not limited to, fibrinopeptide A, d-dimer, thromboxane (and its metabolites), leukotrienes, chemokines, interleukins, and bacterial, chlamydial, viral and mycoplasma antigens. Although the general intent of methodologies such as those disclosed in the Baddour and Vaughn patents may be somewhat similar to some of the purposes of the present invention, they fail to provide an apparatus for collecting condensate and then injecting approximately 50-500 μL of condensate from a tip into the immunoassay kit. In addition, a need exists for a device from which the condensate sample may be delivered to an arterial blood gas machine for analysis of pH, pCO 2 , pO 2 , lactate, urea, glucose and electrolytes. 
     The Baddour device is designed to collect exhaled breath condensate from patients with asthma. The Baddour device does not describe a plunger that extrudes the sample, but describes a “duckbill” valve that appears to be an internal chamber for sample collection. This must be removed and requires additional steps before the sample can be analyzed. Baddour fails to disclose a tip which can be used to dispense the condensate onto the immunoassay filter, and fails to disclose a system of snaps to lock the handle of the plunger in its “closed” position. All of these features are very useful in facilitating simple breath condensate collection and analysis. Neither the specific objective of injecting the sample onto a port of an immunoassay, nor the objective of being able to use the condenser as a delivery unit to perform point-of-care pH, gas tension, lactate and urea measurements can be done with either the Baddour or Vaughn device. 
     Although the Vaughn device appears to propose the use of an endothermic reaction to cool a condensing chamber, it does not disclose a means of packaging the reaction to make it easy to use at the patient&#39;s bedside. The Vaughn device also requires a complicated methodology for expressing collected condensate from a side port of the condensing chamber. A need exists for a simpler methodology. 
     No prior art device uses a flow transducer to indicate when an adequate volume of breath has been collected, or provides visual or aural feedback as to the rate and completion percentage. A device having such features would be much more convenient to use than prior art devices. 
     Further, no prior art device uses a high efficiency, miniature refrigeration unit, disposed within the breath collection device itself, to cool the breath condenser. Such a system would allow a new condensing chamber to be cooled rapidly without storing the chamber beforehand in a freezer and without resorting to means such as an endothermic reaction to provide a cooling effect. 
     A need exists for a full-featured breath condensate collection apparatus for separating alveolar phase exhaled breath from expired airway phase exhaled breath, having improved cooling features, a housing that substantially encloses the various components in order to protect them, to protect the user from uncomfortable heat or cold produced thereby, to avoid contamination to or from the components, to provide greater convenience of use to the user, and to provide built-in analysis of the condensate collected therein. 
     SUMMARY OF THE PRESENT INVENTION 
     The device is designed to allow selective collection of breath condensate contained within the alveolar volume of expired breath. The device consists of port into which a patient breathes, connected in fluid series to a chamber with a port to allow transmission and measurement of percentage absorption of a light beam in the exhaled sample. In a preferred embodiment, when the concentration of CO 2  increases above a specified threshold, or increases at a specified rate, a rotary solenoid is actuated which is connected to a valve. This action causes the valve to rotate 90°, causing the exhaled breath to be diverted into a condensing chamber. 
     Other general features include a built-in refrigeration system, a built-in analyzer, a flow transducer and microcontroller for measuring total volume of exhaled breath and signaling the user when a sufficient volume has been detected, and a housing in which the various components may be carried, including some disposable components and some reusable components. 
     Broadly defined, the present invention according to one aspect is a method of diagnosing particular diseases based on expired breath from a mammalian subject, including: providing a breath condensate collection device having condensing chamber, a fluid inlet and a fluid outlet; cooling the condensing chamber; receiving, at the fluid inlet, at least one exhaled breath from a mammalian subject; separating the exhaled breath into an expired airway phase volume and an alveolar phase volume; condensing portions of either the expired airway phase portion of the exhaled breath or the alveolar phase volume of the exhaled breath, but not both, in the condensing chamber to produce condensate on the inner surfaces of the condensing chamber; removing the condensate from the condensing chamber; analyzing the condensate for markers indicative of respiratory disease; and rendering a diagnosis at least partly on the basis of whether the condensate being analyzed came, from the expired airway phase portion of the exhaled breath or the alveolar phase volume of the exhaled breath. 
     In features of this aspect, the separating takes place between the fluid inlet and the condensing chamber; the markers include biochemicals; the biochemicals include inorganic gases, volatile organic molecules, proteins, nucleic acids, lipids, lipid A, endotoxin and other impervious nonorganic exogenous materials; the markers include microbes; the microbes include viruses, fungi, mycoplasma, mycobacteria, bacteria, prions and protozoa; only the alveolar phase volume of the exhaled breath reaches the condensing chamber; alternatively, only the expired airway phase volume of the exhaled breath reaches the condensing chamber; the receiving, separating and condensing steps are repeated in order to increase the amount of condensate produced in the condensing chamber; and the method further includes expressing the condensate from the condensing chamber using a piston assembly. 
     Broadly defined, the present invention according to another aspect is a method of collecting breath condensate from a portion of exhaled breath from a mammalian subject by separating the expired airway phase of the breath from the alveolar phase, including: providing a cartridge assembly and a condensing chamber, the cartridge assembly having a breathing port and at least two fluid outlets, at least one of which is in fluid communication with the condensing chamber; cooling the condensing chamber; receiving, at the breathing port in the cartridge assembly, at least one exhaled breath from a mammalian subject; monitoring, in the cartridge assembly, at least one characteristic of the exhaled breath, the characteristic generally capable of distinguishing the expired airway phase of the breath from the alveolar phase of the breath; based on the state of the monitored characteristic, diverting the flow of the exhaled breath through the cartridge assembly from one fluid outlet to the other fluid outlet; and upon receiving a diverted portion of the exhaled breath from the cartridge assembly, condensing portions of the exhaled breath to produce condensate on the inner surfaces of the condensing chamber. 
     In features of this aspect, monitoring includes determining when the exhaled breath has transitioned from the expired airway phase to the alveolar phase, and diverting the flow of the exhaled breath based on the state of the monitored characteristic includes diverting the exhaled breath to the condensing chamber once it is determined that the alveolar phase of the exhaled breath has begun; cooling the condensing chamber includes cooling the condensing chamber to a temperature of less than 0° F.; the diverting step includes adjusting the state of a valve assembly to prevent the exhaled breath from passing into the condensing chamber until the alveolar phase of the exhaled breath has begun and to force the exhaled breath into the condensing chamber once the alveolar phase of the exhaled breath has begun; cooling the condensing chamber includes cooling the condensing chamber to a temperature of less than 0° C.; and the method further includes expressing the condensate from the condensing chamber using a piston assembly. 
     In other features of this aspect, determining when the exhaled breath has transitioned from the expired airway phase to the alveolar phase includes determining when a predetermined level of a particular predetermined gas is reached; the particular predetermined gas is selected from the group consisting of CO 2 , O 2 , N 2 , CO and NO; the monitoring, diverting and condensing steps are repeated in order to increase the amount of condensate produced in the condensing chamber; the monitoring, diverting and condensing steps are repeated for a predetermined period of time; the monitoring, diverting and condensing steps are repeated until a predetermined volume of gas has passed into the condensing chamber; the monitoring and diverting steps are carried out automatically; and monitoring includes determining when the exhaled breath has transitioned from the expired airway phase to the alveolar phase, and diverting the flow of the exhaled breath based on the state of the monitored characteristic includes diverting the exhaled breath to the condensing chamber until it is determined that the alveolar phase of the exhaled breath has begun. 
     Broadly defined, the present invention according to another aspect is breath condensate collection apparatus including: a cartridge assembly having a breathing port adapted to permit a mammalian subject to breathe in and out of the cartridge assembly, at least a first fluid outlet and a second fluid outlet, a monitoring system adapted to monitor at least one characteristic of a generally gaseous fluid passing through the cartridge assembly, the at least one characteristic generally capable of distinguishing the expired airway phase of an exhaled breath from the mammalian subject from the alveolar phase of the exhaled breath, and a valve assembly operable to divert the flow of fluid, received via the breathing port, to either the first fluid outlet or the second fluid outlet on the basis of the state of the monitored characteristic; and a condensing chamber having double&#39;side walls, including an inner side wall and an outer side wall in spaced relationship to one another, and first and second opposing ends, the condensing chamber being in fluid communication with at least one fluid outlet of the cartridge assembly. 
     In features of this aspect, the condensing chamber includes an outlet and a one-way valve adapted to prevent gas from being drawn into the condensing chamber during an inhalation by the mammalian subject while permitting exhaled breath to be exhausted therethrough during an exhalation by the mammalian subject; the condensing chamber is cooled to a temperature of less than 0° F.; the condensing chamber is cooled to a temperature of less than 0° C.; the apparatus further includes a plunger assembly having a piston and a handle, the piston being slidably disposed in the interior of the condensing chamber in snug contact with the inner side wall and the handle extending from the first end of the condensing chamber so as to permit the piston to be moved within the central chamber; and in addition to the first one-way valve, the cartridge assembly further includes an inhalation port and a second one-way valve adapted to permit breathing gas to be drawn into the cartridge assembly during an inhalation by the mammalian subject, and the cartridge assembly further includes a third one-way valve in at least one of the at least two fluid outlets adapted to prevent gas from being drawn into the cartridge assembly during an inhalation by the mammalian subject while permitting exhaled breath to be exhausted therethrough during an exhalation by the mammalian subject. 
     In other features of this aspect, the actuator device operates the valve assembly to divert the flow of fluid, received via the breathing port, to the second fluid outlet instead of to the first fluid outlet when a predetermined level of a particular predetermined gas is reached; the predetermined level is reached by the level of the predetermined gas rising to the predetermined level; the predetermined level is reached by the level of the predetermined gas dropping to the predetermined level; the particular predetermined gas is selected from the group consisting of CO 2 , O 2 , N 2 , CO and NO; the breathing port, the at least two fluid outlets and the valve assembly define a cartridge, and the apparatus further includes a housing adapted to carry the cartridge, the monitoring system and the condensing chamber; and the cartridge is adapted to be removable from the housing for disposal after a single use, while the monitoring system is adapted for repeated reuse. 
     In still further features of this aspect, the actuator device operates the valve assembly to divert the flow of fluid, received via the breathing port, to the fluid outlet connected to the condensing chamber when the predetermined level of the particular. predetermined gas is reached; the actuator device operates the valve assembly to divert the flow of fluid, received via the breathing port, away from the fluid outlet connected to the condensing chamber when the predetermined level of the particular predetermined gas is reached; the valve assembly includes a valve adjustable between at least two positions, such that in the first valve assembly state the valve is in a first position diverting fluid received at the breathing port to the first fluid outlet and away from the second fluid outlet, and in the second valve assembly state the valve is in a second position diverting fluid received at the breathing port to the second fluid outlet and away from the first fluid outlet; the valve is a directional flap; the actuator device is a rotary solenoid; and the valve assembly includes at least two valves. 
     Broadly defined, the present invention according to another aspect is an apparatus for separating the expired airway phase of breath exhaled by a mammalian subject from the alveolar phase of the exhaled breath, including: a fluid inlet; at least a first fluid outlet and a second fluid outlet; a valve assembly adjustable between at least two states: a first state wherein fluid received at the fluid inlet is diverted to the first fluid outlet, and a second state wherein fluid received at the fluid inlet is diverted to the second fluid outlet; and a control system that adjusts the state of the valve assembly, having a spectrometer arranged to monitor at least one characteristic of a generally gaseous fluid passing through the separation apparatus, the characteristic generally capable of distinguishing the expired airway phase of an exhaled breath from a mammalian subject from the alveolar phase of the exhaled breath, and an actuator device, coupled to the spectrometer and the valve assembly, that adjusts the state of the valve assembly on the basis of the state of the monitored characteristic. 
     In features of this aspect, the spectrometer is arranged to measure the partial pressure of a particular predetermined gas in the gaseous fluid passing through the separation apparatus; the actuator device adjusts the state of the valve assembly from its first state to its second state when the partial pressure of the particular predetermined gas reaches a predetermined level; the partial pressure reaches the predetermined level by rising to the predetermined level; the partial pressure reaches the predetermined level by dropping to the predetermined level; the particular predetermined gas is selected from the group consisting of CO 2 , O 2 , N 2 , CO and NO; the fluid inlet, the at least two fluid outlets and the valve assembly define a cartridge assembly, and the apparatus further includes a housing adapted to carry the cartridge assembly and the control system; and the cartridge assembly is adapted to be removable from the housing for disposal after a single use, while the control system is adapted for repeated reuse. 
     In other features of this aspect, the apparatus further includes a chamber having an inlet connected in fluid communication with one of the at least two fluid outlets and adapted to collect at least a portion of the generally gaseous fluid passing through the separation apparatus; the chamber is a condensing chamber adapted to collect liquid condensed out of the generally gaseous fluid; the chamber is connected to the second fluid outlet, and the actuator device adjusts the valve assembly from the first state to the second state when the partial pressure reaches the predetermined level; the chamber is connected to the second fluid outlet, and the actuator device adjusts the valve assembly from the second state to the first state when the partial pressure reaches the predetermined level; the valve assembly includes a valve adjustable between at least two positions such that in the first valve assembly state the valve is in a first position diverting fluid received at the fluid inlet to the first fluid outlet and away from the second fluid outlet, and in the second valve assembly state the valve is in a second position diverting fluid received at the fluid inlet to the second fluid outlet and away from the first fluid outlet; the valve is a directional flap; the actuator device is a rotary solenoid; and the valve assembly includes at least two valves. 
     Broadly defined, the present invention according to another aspect is a breath condensate collection apparatus including: a housing; a condensing chamber, carried by the housing, having an inlet that receives exhaled breaths from a mammalian subject and an outlet that permits a gaseous, non-condensed portion of the exhaled breaths to escape from the condensing chamber; and a built-in refrigeration system, carried by the housing, having a compressor, an expansion valve, an evaporator pipe arranged to cool the condensing chamber, and a condenser-pipe arranged to dissipate heat away from the condensing chamber. 
     In features of this aspect, the housing includes a cavity correspondingly shaped and sized to carry the condensing chamber, and the evaporator pipe is disposed generally around the cavity; when the condensing chamber is carried in the cavity, the condensing chamber makes contact with a substantial portion of the evaporator pipe; the condensing chamber has walls constructed from a good heat conducting material; the walls of the condensing chamber are constructed from aluminum; the apparatus further includes a ventilation system that dissipates heat generated by the refrigeration system; the ventilation system includes one or more vents in the housing; the ventilation system includes one or more fans; and the apparatus further includes a temperature gauge arranged to provide an indication of the temperature of the condensing chamber. 
     Broadly defined, the present invention according to another aspect is a portable breath condensate collection apparatus including: a housing having at least one compartment adapted to receive and generally enclose a removable cartridge and a removable condensing chamber in fluid communication with one another; a removable, disposable cartridge, having at least one inlet, at least one outlet and a mouthpiece in fluid communication with at least one inlet, carried in the at least one compartment of the housing such that at least a portion of the mouthpiece is carried externally to the housing; and a removable condensing chamber, having an inlet and an outlet, carried in the at least one compartment of the housing such that the inlet is in fluid communication with at least one outlet of the cartridge and the outlet is open to the environment. 
     In features of this aspect, the at least one compartment includes a compartment having a first section and a second section, the cartridge is carried in the first compartment section and the condensing chamber is carried in the second compartment section; alternatively, the at least one compartment includes at least a first compartment and a second compartment, the cartridge is carried in the first compartment and the condensing chamber is carried in the second compartment; the cartridge includes a valve assembly for alternately permitting or preventing the flow of fluids through the cartridge and into the condensing chamber; the apparatus further includes a control system, carried by and generally enclosed in the housing, for the valve assembly; and the control system is adapted to remain in the housing for repeated reuse while the cartridge and the condensing chamber are removed. 
     In other features of this aspect, the apparatus further includes an analyzer, carried by and generally enclosed in the housing, adapted to provide information regarding the content of breath condensate received therein, and a conduit disposed in sealed fluid communication between the condensing chamber and the analyzer, adapted to guide breathe condensate from the condensing chamber to the analyzer; wherein the condensing chamber further includes a piston and a handle, the piston is slidably disposed in the interior of the condensing chamber in snug contact with the inside of the condensing chamber and the handle extends from the first end of the condensing chamber so as to permit the piston to be moved within the central chamber; and the piston is operable to force breath condensate collected in the condensing chamber to the conduit leading to the analyzer. 
     Broadly defined, the present invention according to another aspect is a breath condensate collection apparatus including: a housing; a condensing chamber, carried by the housing; an inlet, carried by the housing, that receives exhaled breath from a mammalian subject; a conduit disposed in sealed fluid communication between the inlet and the condensing chamber; a gas flow measurement device, disposed in the conduit, that measures the flow of gas through the conduit; and a control system, coupled to the gas flow measurement device, that determines when a predetermined volume of gas has passed through the conduit. 
     In features of this aspect, the conduit, the gas flow measurement device and the control system are carried by the housing; the apparatus further includes a signaling device that generates a user-identifiable indication that the predetermined volume of gas has passed through the conduit; the gas flow measurement device is a gas flow transducer and the control system includes a microcontroller that is electrically connected to the gas flow transducer; the signaling device includes a speaker that generates a user-audible signal; the user-audible signal changes, as a mammalian subject breathes through the apparatus, to provide an indication of progress toward reaching the predetermined volume of gas; the signaling device includes at least one user-visible light; and the at least one user-visible light includes a plurality of user-visible lights that light sequentially, as a mammalian subject breathes through the apparatus, to provide an indication of progress toward reaching the predetermined volume of gas. 
     Broadly defined, the present invention according to another aspect is a breath condensate collection apparatus for separating the expired airway phase of breath exhaled by a mammalian subject from the alveolar phase of the exhaled breath, including: a housing; a cartridge assembly having a breathing port, at least two fluid outlets, a valve assembly adjustable between at least two states, including a first state wherein gas received at the breathing port is diverted to a first of the at least two fluid outlets, and a second state wherein gas received at the breathing port is diverted to a second of the at least two fluid outlets, a monitoring system arranged to monitor at least one characteristic of gas passing through the separation apparatus, the characteristic generally capable of distinguishing the expired airway phase of an exhaled breath from a mammalian subject from the alveolar phase of the exhaled breath, and an actuator device, coupled to the monitoring system and the valve assembly, that adjusts the valve assembly state on the basis of the state of the monitored characteristic; a condensing chamber, having an inlet and an outlet, carried by the housing such that the inlet is in fluid communication with at least one outlet of the cartridge assembly and the outlet is open to the environment; and a built-in refrigeration system, carried by the housing. 
     In features of this aspect, the housing includes at least one compartment adapted to receive and generally enclose the cartridge assembly and the condensing chamber in fluid communication with one another; the condensing chamber is adapted to be removed from the housing after use and replaced by a previously-unused condensing chamber; the cartridge assembly is adapted to be removed from the housing after use and replaced by an unused cartridge assembly; the condensing chamber has double side walls and first and second opposing ends, and the double side walls include an inner side wall and an outer side wall in spaced relationship to one another; the built-in refrigeration system includes a compressor, an expansion valve, an evaporator pipe arranged to cool the condensing chamber, and a condenser pipe arranged to dissipate heat away from the condensing chamber; and the apparatus further includes a conduit disposed in sealed fluid communication between the valve assembly and the condensing chamber, a gas flow measurement device, disposed in the conduit, that measures the flow of gas through the conduit, and a control system, coupled to the gas flow measurement device, that determines when a predetermined volume of gas has passed through the conduit. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Further features, embodiments, and advantages of the present invention will become apparent from the following detailed description with reference to the drawings, wherein: 
         FIG. 1  is a side view of a device for collection of exhaled alveolar breath condensate in accordance with a preferred embodiment of the present invention; 
         FIG. 2  is a front view of the device of  FIG. 1 ; 
         FIG. 3  is a top view of the housing of  FIG. 1  with the cartridge lid removed to show the cartridge assembly; 
         FIG. 4  is a top view of the housing of  FIG. 1  with the cartridge assembly and the syringe removed; 
         FIG. 5  is a side cross-sectional view of the device of  FIG. 2 , taken along line  5 - 5 ; 
         FIG. 6  is a schematic view of the cartridge assembly of  FIG. 3 ; 
         FIG. 7  is an enlarged perspective view of the cartridge of  FIG. 1 ; 
         FIG. 8  is a right side view of the cartridge of  FIG. 7 ; 
         FIG. 9  is a top view of the cartridge of  FIG. 7 ; 
         FIG. 10  is a rear view of the cartridge of  FIG. 7 ; 
         FIG. 11  is a side view of the directional flap of  FIG. 7 ; 
         FIG. 12  is a side perspective view of the directional flap of  FIG. 7 ; 
         FIG. 13  is a partially-schematic side cross-sectional view of the cartridge of  FIG. 10 , taken along line  13 - 13 , showing the directional flap in a closed position; 
         FIG. 14  is a partially-schematic side cross-sectional view of the cartridge of  FIG. 10 , taken along line  13 - 13 , showing the directional flap in an open position; 
         FIG. 15  is a left side view of the cartridge of  FIG. 7  showing the attachment of a spring to the directional flap; 
         FIG. 16  is a rear view of the cartridge assembly of  FIG. 3 , shown removed from the housing; 
         FIG. 17  is an enlarged perspective view of the rotary solenoid of  FIG. 16 ; 
         FIG. 18  is a side view of a first exemplary syringe for use in the device of  FIG. 1 ; 
         FIG. 19  is a front view of the syringe of  FIG. 18 ; 
         FIG. 20  is a side cross-sectional view of the syringe of  FIG. 19 , taken along line  20 - 20 ; 
         FIG. 21  is a side cross-sectional view of a device for collection of exhaled alveolar breath condensate in accordance with a second preferred embodiment of the present invention; 
         FIG. 22  is a side cross-sectional view of a device for collection of exhaled alveolar breath condensate in accordance with a third preferred embodiment of the present invention; 
         FIG. 23  is a side cross-sectional view of the device of  FIG. 22  showing the plunger assembly in a fully inserted position; and 
         FIG. 24  is a schematic view of an auxiliary control system for use with the device of  FIGS. 1 ,  21  and  22 . 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Referring now to the drawings, in which like numerals represent like components throughout the several views, the preferred embodiments of the present invention are next described. The following description of the preferred embodiment(s) is merely exemplary in nature and is in no way intended to limit the invention, its application, or uses. 
       FIG. 1  is a side view of a device  10  for collection of exhaled alveolar breath condensate in accordance with a preferred embodiment of the present invention. The device  10  includes a housing  12 , a disposable mouthpiece  14 , a handle  16 , an intake cartridge assembly  20  and a syringe  80 . The size and shape of the housing  12  and the handle  16  are designed to permit the device  10  to be readily held by a patient, but the device  10  may also be mounted on the side of a hospital bed or gurney, attached to a rolling mobile stand, or the like, using suitable mounting hardware (not shown). 
       FIG. 2  is a front view of the device  10  of  FIG. 1 . The housing  12  is generally cylindrical and is designed to support the intake cartridge assembly  20  and the syringe  80  therein. The housing  12  includes a cartridge lid  13  secured to the remainder of the housing  12  by a hinge  11 . The cartridge lid  13  may thus be opened to facilitate access to the cartridge assembly  20  disposed inside the housing  12 . 
       FIG. 3  is a top view of the housing  12  of  FIG. 1  with the cartridge lid  13  removed to show the cartridge assembly  20 ,  FIG. 4  is a top view of the housing  12  of  FIG. 1  with the cartridge assembly  20  and the syringe  80  removed, and  FIG. 5  is a side cross-sectional view of the device  10  of  FIG. 2 , taken along line  5 - 5 . As shown therein, the housing  12  may include a variety of compartments, recesses, pockets or the like for receiving the various components of the device  10 . In particular, one end of the housing  12  may be devoted to the components of the cartridge assembly  20 , while the other end houses the syringe  80 . The housing  10  includes a cartridge compartment, a two spectrometer pockets, an actuator pocket, and other pockets and recesses for various parts and functions described below. In addition, the housing  12  includes external openings through at each end as well as two openings in its bottom and an opening penetrating the cartridge lid  13 . The purpose of each of these openings will become apparent hereinbelow. 
       FIG. 6  is a schematic view of the cartridge assembly  20  of  FIG. 3 . The cartridge assembly  20  includes a disposable cartridge  22  and a control system  60 . The control system  60  is used to control a directional flap  36  in the cartridge  22 , which regulates the path of exhaled breath through the cartridge  22 . The operation of the control system  60  and the cartridge  22  will be more fully described hereinbelow. 
       FIGS. 7-10  are perspective, right side, top and rear views of the cartridge  22  of  FIGS. 5 and 6 . The cartridge  22  may be formed from polyethylene, polycarbonate, polyvinyl, plastic, glass or the like and includes a breathing port  24 , an inhalation port  26 , an absorption chamber  28 , a collection port  30 , an exhaust vent  32 , a pair of spectrometer windows  34  and a valve assembly that may include the directional flap  36 , a spring  50  and a pin or boss  52  protruding from an exterior surface of the cartridge  22 . The breathing port  24  is fluidly connected between the absorption chamber  28  and the mouthpiece  14  to permit a user to breathe in and out through the cartridge  22 . The inhalation port  26  includes a one-way valve  27  that permits ambient air to be drawn through the cartridge  22  during the user&#39;s inhalation cycle. The collection port  30  is in fluid communication with the syringe  80  and includes a one-way valve  31  to prevent gases in the syringe  80  from returning to the cartridge  22 . The exhaust vent  32  permits unwanted exhaled breath to be vented to the environment and includes a one-way valve  33  to prevent air from entering the cartridge  22  therethrough. It should be noted that although  FIGS. 7 and 10 , and some of the other illustrations, show the exhaust vent  32  as being round, it may be preferable for the exhaust vent  32  to be rectangular or some other shape. The emitter and sensor units  64 ,  66  of a spectrometer or other monitoring system  62  may be stationed adjacent the spectrometer windows  34 , as described below, in order to measure the content of gas contained in the absorption chamber  28  of the cartridge  22 . 
       FIGS. 11 &amp; 12  are side and perspective views, respectively, of the directional flap  36  of  FIG. 7 . The directional flap  36  includes a central shaft  37 , arranged around an axial pin  44 , from which a deflector plate  38  is supported by a pair of arms  39 ,  41 . As illustrated in  FIG. 8 , a pair of tabs  40 ,  42  extend laterally from the ends of a flange  43 , supported by the central shaft  37 , for purposes made clear hereinbelow. The directional flap  36  may be adjusted to force the exhaled breath in the interior of the cartridge  22  to be exhausted either through the collection port  30  or the exhaust vent  32 . As perhaps best shown in  FIGS. 8 and 9 , the flap  36  is supported in the interior if the cartridge  22  by the arms  39 ,  41 , which extend through slots  45  in the sides of the cartridge  22 . 
       FIGS. 13 and 14  are partially-schematic side cross-sectional views of the cartridge  22  of  FIG. 10 , taken along line  13 - 13 , showing the directional flap  36  in a closed position and an open position, respectively. In the closed position shown in  FIG. 13 , the deflector plate  38  blocks the air path to the collection port  30  that forms the portal between the cartridge  22  and the syringe  80 . This forces all expelled breath to be exhausted through the exhaust vent  32 . On the other hand, in the open position shown in  FIG. 14 , the deflector plate  38  covers the exhaust vent  32 , forcing all expelled breath through the collection port  30  and into the syringe  80 . Preferably, gaskets  46 ,  48  or other sealing devices and methods may be used to seal the deflector plate  38  and any other necessary surfaces of the directional flap  36  to the various internal structures of the cartridge  22  in order to ensure that gases of the wrong type are not passed through the wrong opening. 
       FIG. 15  is a left side view of the cartridge  22  of  FIG. 7  showing the attachment of the spring  50  to the directional flap  36 . The spring  50  or an equivalent device is preferably provided in order to bias the directional flap  36  in a normally-closed position. One purpose of this is to prevent gases and fluids collected in the syringe  80  from escaping back through the cartridge  22 . In one embodiment, the spring  50  is a simple coil spring that is interconnected between one of the tabs  42  on the directional flap  36  and the boss  52  on the exterior surface of the cartridge  22 , as perhaps best shown in  FIGS. 9 and 10 . Other biasing devices and methods will be apparent to one of ordinary skill in the art. 
     Moreover, it will be apparent that the valve assembly may take on any number of different constructions. For example, the directional flap  36  and the biasing device may be internalized within the cartridge  22  in order to provide better sealing, improve operation, or the like. Further, the valve assembly may include two flap-type valves operating in conjunction with each other instead of the single flap  36  disclosed and described herein, or the directional flap  36  may be replaced with a valve mechanism of any suitable alternative type, including but not limited to one rotary valve, a sliding door, a slip barrel, a plunger, or the like, with corresponding changes to the cartridge, biasing device, and the like being apparent to those of skill in the art. 
     Returning to  FIG. 6 , the control system  60  includes a monitoring system  62 , a control unit  67  and an actuator device  70 . The control unit  67  may include an amplifier/differentiator  68  and a monitoring system controller  69 . A variety of monitoring systems may be employed using different physical phenomena as triggers for the directional flap. One monitoring system  62  suitable for use in the preferred embodiments of the present invention is a spectrometer, which may be of any conventional type, including infrared (IR), laser, and the like, and includes a radiation source, or emitter unit  64 , disposed on one side of the absorption chamber  28  and a sensor unit  66  disposed on the opposite side, adjacent the spectrometer windows  34 .  FIG. 16  is a rear view of the cartridge assembly  20  of  FIG. 3 , shown removed from the housing  12 . In operation, radiation from the emitter unit  64  passes through the spectrometer window on one side of the cartridge  22 , through the absorption chamber  28  and through the absorption window  34  to the sensor unit  66 , where the received radiation is analyzed. 
     IR spectrometers may use chopped IR light emission, where the emission is chopped at a frequency appropriate to distinguish absorbance of the gas of interest, such as CO 2 , from background absorbance. Alternatively, laser diode spectrometry can be used for detection of more than one gas for the purpose of actuating the directional flap and for the purpose of determining the presence of various pathophysiological processes that are specific to certain disease states. Lasers using AlGaAs, AlGaInP or a Vertical Cavity diodes operating in the near infrared or visible light spectrum at room temperature and ambient pressure in the 1-100 mW power range will be sufficient. The physical length between the emission and detection probe will be approximately 1-3 cm, but the apparent pathlength may be increased by light reflection using dielectrim mirrors to increase sensitivity. Detection wavelengths will be 1390 nm for CO 2  and 760 nm for O 2 , but other gases may be detected by the laser to assist in diagnosis of specific diseases, including lung ischemia, by the detection of the relative amounts of nitric oxide (NO) at 1800 nm and carbon monoxide (CO) at 1570 nm. It is anticipated that further research will reveal significance of laser-based quantification of other inorganic gases and volatile organic compounds to serve as adjuncts to the chemical analyses of the breath condensate in arriving at a final diagnosis of certain disease processes. 
     Spectrometers are available from a variety of manufacturers, and the selection and implementation of one suitable for use with the present invention would be apparent to one of ordinary skill in the art. As is well known, the sensor unit  66  measures the percent transmission of the radiation to allow measurement of the partial pressure of certain gases in the absorption chamber  28 . Measured gases may include carbon dioxide, oxygen, nitrogen, nitrogen oxides, carbon monoxide, aliphatic and aromatic hydrocarbons, isoprostenoid derivatives, or amino acids dissolved in exhaled aerosolized droplets. 
     One type of actuator device  70  suitable for use in the preferred embodiments of the present invention is a rotary solenoid. The rotary solenoid  70  utilizes a clutch mechanism to adjust or move the directional flap  36  back and forth between its open and closed positions.  FIG. 17  is an enlarged perspective view of the rotary solenoid  70  of  FIG. 16 . As illustrated therein, an actuator shaft  74  extends from the solenoid body  72 . A slot  76  in the end of the actuator shaft  74  may be firmly coupled to one of the tabs  40  on the directional flap  36  in order to provide rotational movement to the tab  40  and likewise rotating the directional flap  36  between its open and closed positions. If necessary, the directional flap tab  40  and the actuator shaft  74  of the rotary solenoid  70  may be disposed coaxially with the pin  44  of the directional flap in order to minimize wear on the components. Rotary solenoids  70  are available from a variety of manufacturers, and the selection and implementation of one suitable for use with the present invention would be apparent to one of ordinary skill in the art. It should also be apparent that other actuating devices and methods may be employed without departing from the scope of the present invention, including pulley mechanisms, magnetic actuation of a metallic valve, and the like, triggered from expired volume measured from a flow transducer rather than from light-absorption technique. 
       FIGS. 18 and 19  are side and front views, respectively, of a first exemplary syringe  80  for use in the device  80  of  FIG. 1 . As illustrated therein, the syringe  80  includes an insulated condensing chamber  82  having a plunger assembly  84 , an inlet  86  and an exhaust port  88 . The condensing chamber  82  may be constructed of any suitable material, including, but not limited to, glass, plastic, polyethylene, polycarbonate, or polyvinyl or other synthetic polymer. 
       FIG. 20  is a side cross-sectional view of the syringe  80  of  FIG. 18 , taken along line  20 - 20 . As shown therein, the insulative effect of the condensing chamber  82  may be provided by any of a variety of materials either formed directly into the walls (not illustrated) of the condensing chamber or sandwiched between an inner wall  90  and an outer wall  92 . Arranged peripherally between the inner and outer walls  90 ,  92  is a layer of a material  94  suitable for creating an endothermic reaction, such as NH 4 NO 3 , that has been vacuum-packed and sealed. The condensing chamber  82  is preferably provided with a needle port  96  or some other means for permitting the sealed material  94  to be hydrated or otherwise injected with a readily available catalyst in order to trigger an endothermic reaction when the syringe  80  is ready to be used. If NH 4 NO 3  is to be used, then the NH 4 NO 3  may be hydrated with water in a 1:4 molar ratio. Such a material is preferred because a user may trigger the reaction by injecting the NH 4 NO 3  material with a preset volume of tap water or saline via the needle port  96 , similar to the way a nurse would “flush” an IV line. However, other materials may likewise be used to create a suitable endothermic reaction. 
     The inner surfaces of the condensing chamber  82  define a central cylinder in which is fitted the plunger assembly  84 . The plunger assembly  84  includes a piston  98 , a rubber gasket  100 , a handle  102  extending from one end of the condensing chamber  82 , and a clip assembly  104  disposed at the handle end of the condensing chamber  82 . The inlet  86  is preferably disposed at the opposite end of the condensing chamber  82  from the plunger assembly  84  and may be arranged in the form of a nipple. The exhaust port  88  is preferably disposed at the same end of the condensing chamber  82  as the handle  102  and is equipped with a one-way valve  106  to permit gases passing through the condensing chamber  82  to be exhausted therethrough while preventing ambient gases from entering the condensing chamber  82 . 
     Although not shown herein, a second exemplary syringe suitable for use (with minor modifications) in the device  10  of  FIG. 1  is a double-walled syringe of a type somewhat similar to one disclosed in the commonly-assigned U.S. Provisional Patent Application No. 60/434,916, filed Dec. 20, 2002. The construction of this syringe is similar to that of the first, except that the space between the inner and outer walls of the condensing chamber is filled with water, polyethylene glycol (“PEG”), or another suitable coolant material and the outer wall is then sealed to the inner wall to prevent leakage. A syringe of this type may be cooled by placing it in a standard freezer prior to use in order to lower the temperature of the syringe to less than 0° F., and preferably to less than 0° C. Details of this type of syringe are provided in the aforementioned provisional patent application. 
     In operation, the housing lid  13  is opened and the cartridge assembly  20  is inserted into the housing  12  such that the various components are snapped into place in their respective compartments in the housing  12 . Next, a syringe  80  of one of the types described above is retrieved from storage and inserted into the open end of the housing  12 , nipple-shaped inlet  86  first, and pushed inward until the inlet  86  is coupled to the collection port  30  of the cartridge  22 . 
     Depending on the syringe type, the syringe  80  may have been stored in a refrigeration device, such as a conventional household freezer, that is capable of lowering the temperature to less than 0° F., and preferably less than 0° C., in order to freeze the jacket of coolant material  94  contained between the inner and outer walls  90 ,  92  of the condensing chamber  82 . Alternatively, syringes of the endothermic reaction type may merely be stored at an ambient temperature and then cooled to the desired temperature by triggering an endothermic reaction therein when ready for use. If the mouthpiece  14  is stored separately from the rest of the device  10 , then the mouthpiece  14  may be assembled to the cartridge assembly  20 . In some applications, such as when the device  10  is to be attached to a bed or to a rolling stand, it may be useful to connect the mouthpiece  14  to a longer tube (not shown) in sealed fluid communication with the breathing port  24  of the cartridge  22 . 
     Once the device  10  is assembled, the patient positions the mouthpiece  14  in sealed relationship to his mouth area and inhales and exhales through the mouthpiece  14 . When the patient inhales, ambient air enters through the inhalation port  26  via the one-way valve  27 . The exhaled breath is guided into the absorption chamber  28  via the breathing port  24 . Under the control of the monitoring system controller  69 , the spectrometer  62  measures the partial pressure of certain gases in the absorption chamber  28  and delivers an analog current to the amplifier/differentiator  68 . For example, the magnitude of the analog signal may be proportional to the amount of CO 2  present in the absorption chamber  28 . 
     At the beginning of an expiration by the patient, the patient&#39;s breath is dilute in carbon dioxide and rich in oxygen. In one preferred embodiment, the rotary solenoid  70  and the amplifier/differentiator  68  are calibrated such that the directional flap  36  remains in its resting state, wherein the flap  36  is held in its closed position by the spring  50 , and the airway deadspace is shunted out the exhaust vent  32  to the environment. As the patient&#39;s alveoli begin to empty during expiration, the partial pressure of CO 2  increases and the partial pressure of oxygen decreases. The resulting signal generated by the amplifier/differentiator  68  eventually activates the solenoid  70 , causing the directional flap  36  to open. At this point, the alveolar gas and associated water content are directed selectively to the syringe  80 . 
     To maximize the efficiency of collection of breath condensate, the deadspace volume of the cartridge  22  should preferably be minimized to less than 20 mL. It will also be preferable for patients to exhale deeply through the device  10  in order to enhance the amount of condensation in the alveolar phase. Thermodynamic and kinetic modeling has suggested that forced exhalation will enhance the transfer of alveolar water into vapor and droplet phase. Thus the device  10  is preferably designed to impart a small resistance to exhaled flow. The outlet diameter and length of the collection port  30 , connected to the condensing chamber  82 , will be calibrated to provide a small amount of resistance to exhalation, which the patient should be able to detect, but which is not enough to cause exhalation to be excessively laborious. 
     As portions of the expired breath pass into the syringe  80 , the moisture in the breath begins to condense on the inner surfaces of the condensing chamber  82 . Because of the depressed temperature of the condensing chamber  82 , condensate begins to collect and may immediately freeze on the inner surfaces thereof. Once the patient&#39;s breath has warmed the condensing chamber  82  sufficiently, the condensate will melt and may be expressed from the condensing chamber  82 . The construction of the condensing chamber  82  is preferably calibrated to provide a sufficient quantity of condensate (approximately 250 microliters) after a predetermined number of breaths. When sufficient condensate has been collected, the syringe  80  may be removed from the housing  12  and the plunger assembly  84  depressed to force the collected condensate from the nipple  86  as described previously. Finally, once the condensate has been collected and withdrawn, the mouthpiece  14 , the cartridge  22  (but preferably not the control system  60 , which is designed to remain uncontaminated and would be relatively expensive to replace after each use) and the syringe  80  may be disposed of according to conventional waste disposition procedures, and the collected condensate may be taken to a suitable analyzer for analysis. 
     Because of the relatively small quantities of liquid condensate that may typically be collected using devices  10  of the present invention, it may be useful to include specialized features in the piston  98  and other components in order to maximize the amount of condensate that may be collected. For example, although not absolutely necessary, the piston  98  shown in the various illustrations includes a tip or protrusion  99  of dimensions and shape suitable for fitting snugly into the nipple-shaped inlet  86  when the plunger assembly  84  is fully depressed. This helps to ensure that as much condensate as possible is forced out of the inlet  86 . In addition, however, the protrusion  99  may, for example, include grooves, tunnels, or the like for guiding condensate from the condensing chamber  82  to the inlet  86  and out. Specialized pistons  98  such as these are more fully described in the aforementioned U.S. Provisional Patent Application No. 60/434,916. 
     The analysis of the collected condensate may be carried out using any conventional analysis technique or system. The analysis may focus on identifying and quantifying the presence of a variety of markers of various respiratory diseases. The markers may include microbes such as viruses, fungi, mycoplasma, mycobacteria, bacteria, prions and protozoa, and biochemicals such as inorganic gases, volatile organic molecules, proteins, nucleic acids, lipids, lipid A, endotoxin and other impervious nonorganic exogenous materials such as inhaled particulate including asbestos, silicates, coal dust and the like. These markers and the analysis techniques and systems are well known to those of ordinary skill in the art. Once the analysis is complete, however, a more accurate diagnosis may be made by taking into account the exhalation cycle phase or phases in which the markers were found. 
       FIG. 21  is a side cross-sectional view of a device  110  for collection of exhaled alveolar breath condensate in accordance with a second preferred embodiment of the present invention. In this alternative embodiment preferred for its completely self-contained nature, the device  110  includes a refrigeration system  120  built into its housing  112 . The refrigeration system  120  is generally of conventional design and includes a compressor  122 , an expansion valve (not shown), a distribution system  126  and an exhaust system  140 . However, it should be apparent that other types of cooling systems may likewise be utilized without departing from the scope of the present invention. For example, instead of a conventional refrigeration system  120 , the alternative device  110  may utilize a cooling jacket comprised of a layer of a liquid having a very low freezing point, such as PEG, in a bag made of rubber or the like, or may use an electric cooler making use of the thermoelectric effect, or other cooling methodologies. 
     The device  110  may utilize an alternative syringe  180  having a single-walled condensing chamber  182  and a plunger assembly and other features as described herein. The distribution system  126  is a piping or tubing structure having a evaporator (cold) pipe or coil  128  and a condenser (hot) coil  130 . The evaporator coil  128  surrounds the recess into which the condensing chamber  182  is inserted. Although not shown herein, the evaporator coil  128  may even make direct contact with the wall of the condensing chamber  182 . Preferably, the walls of the condensing chamber  182  are formed of aluminum or another good heat conducting material, thus permitting the refrigeration system  120  to rapidly cool the condensing chamber  182 , thus facilitating breath condensate collection within seconds of inserting the syringe  180  therein. 
     The condenser coil  130  may be cooled using convection cooling via the exhaust system  140 , which may include fans  142  and vents  144  such as those shown in the side and end, respectively, of the housing  112  in  FIG. 21 . The exhausted heat should preferably be directed away from the patient. The compressor  122  may operate using standard 110 volt electrical power or using power supplied by a suitable battery pack. A temperature gauge (not shown) may be provided to indicate when the temperature of the condensing chamber  182  has been lowered sufficiently to allow breath condensation to occur with adequate efficiency, which may be important if the device  110  has not been used for an extended period of time. 
       FIG. 22  is a side cross-sectional view of a device  210  for collection of exhaled alveolar breath condensate in accordance with a third preferred embodiment of the present invention. In this alternative embodiment preferred for its still greater functionality and convenience, the device  210  includes a built-in breath condensate analyzer  220 . The built-in analyzer feature may be combined with the built-in refrigeration system  120  described above, or may be utilized separately. In order to deliver the collected condensate to the analyzer  220 , a syringe  280  having a special condensing chamber  282  may be utilized. The condensing chamber  282  differs from previously-described condensing chambers  82 ,  182  in that it includes a small side port  283  extending radially from the entry end of the condensing chamber  282 . This permits collected condensate to be expressed directly into the analyzer  220 . In addition, it should be noted that the plunger assembly  84  must include a tip or protrusion  99  of a type described previously (or a similar structure) in order to completely plug the nipple-shaped inlet  86  of the condensing chamber  282 , thereby preventing condensate from passing back into the cartridge  22  when the plunger assembly  84  is depressed. 
     In use, a syringe  280  is first inserted into the housing  212  of the device  210 . A groove or channel may be provided in the recess of the housing  212  in order to guide the side port  283  into fluid communication with an inlet  221  for the analyzer  220 . If the device  210  is equipped with a built-in refrigeration system  120  as described previously, then the condensing chamber  282  may be cooled once it is in place in the housing  112 ; otherwise, the condensing chamber  282  should be cooled ahead of time. Condensate is then collected in a similar manner to that described hereinabove. When sufficient condensate has been collected, the plunger assembly  84  may be depressed until the plunger handle  102  snaps into place.  FIG. 23  is a side cross-sectional view of the device of  FIG. 22  showing the plunger assembly  84  in a fully inserted position. This forces the analyte out of the side port  283  and into the analyzer  220 , which may include an analysis matrix, such as an immunoassay screen, or permits it to be aspirated by vacuum into an analysis chamber contained within the housing  212  of the device  210 . 
       FIG. 24  is a schematic view of an auxiliary control system  54  for use with the devices  10 ,  110 ,  210  of  FIGS. 1 ,  21  and  22 . The auxiliary control system  54  includes a flow transducer  55 , a microcontroller or other computer device or electronic logic module  56 , and one or more signaling devices  57 ,  58 . The flow transducer  55  may be installed anywhere along the flow path extending from the directional flap  36  in the cartridge  22  to the exhaust port  88  of the respective syringe  80 ,  180 .  280  but is preferably installed at the collection port  30  of the cartridge  22 . The microcontroller  56  is interconnected between the flow transducer  55  and the signaling devices  57 ,  58 . 
     In operation, the flow transducer  55  measures the exhaled alveolar volume passing through the collection port  30  of the cartridge  22  and generates a corresponding analog signal that is monitored by the microcontroller  56 . The exhaled alveolar volume that is required in order to produce the volume of condensate needed for accurate chemical analyses can be preprogrammed, based upon experimental analysis, into the microcontroller  56 . When the microcontroller  56  determines that that volume has been reached, it transmits a suitable electronic signal to the signaling devices  57 ,  58 , which may include a speaker, one or more LED&#39;s or other visual signal devices, or the like. Thus, when the speaker  57  sounds or the LED&#39;s  58  light, the operator of the respective device  10 ,  110 ,  210  is notified that the breath collection process has been completed. Alternatively, the microcontroller  56  may utilize a more complex signaling pattern, wherein the audible signal emitted by the speaker  57  rises in pitch or in intensity as the process progresses, or a series of LED&#39;s  58  are sequentially lit as the process progresses. This approach allows the patient and operator to know how much more breathing is required to complete condensation collection, which may be particularly advantageous for breath collection from children. 
     It should be apparent that the devices  10 ,  110 ,  210  of various embodiments of the present invention may also be used to capture expired breath from the expired airway phase, rather than the alveolar phase, merely by reversing the triggering point for the solenoid  70 . This may be accomplished by calibrating the rotary solenoid  70  and the amplifier/differentiator  68  such that the directional flap  36  is initially held in its active state, wherein the flap  36  is held in its open position by the solenoid  70 . Alternatively, the spring  50  or other biasing means may be adjusted to bias the directional flap  36  in its open position, and the control system  60  may be adjusted such that when the solenoid  70  is activated, the flap  36  is closed. 
     The operation of this variation is as follows. As described previously, at the beginning of an expiration by the patient, the patient&#39;s breath is dilute in carbon dioxide and rich in oxygen. Thus, when the flap  36  is open, the airway deadspace and associated water content are directed selectively to the syringe  80 . As the patient&#39;s alveoli begin to empty during expiration, the partial pressure of CO 2  increases and the partial pressure of oxygen decreases. The resulting signal generated by the amplifier/differentiator  68  eventually deactivates the solenoid  70 , causing the directional flap  36  to close. At this point, the alveolar gas is shunted out the exhaust vent  32  to the environment. The threshold concentration value for CO 2  is preferably set at approximately 4 torr, so that once the concentration of CO 2  exceeds that value, the actuator device  70  closes the flap  36 , thus preventing further exhaled breath from passing into the syringe  80 . 
     Thus, this alternative arrangement may be used to provide specific separation of the expired airway phase from the alveolar phase. More specifically, this would allow selective spectrophotometric measurement of expired concentrations of inorganic gases and volatile organic compounds, as well as collection of expired condensate derived only from the airway phase of exhalation. Then, the condensing chamber  82  could be replaced and the triggering mechanism could be reset to alveolar collection mode, and the process repeated. Because the condensate collected during alveolar collection mode would be from the same subject as that collected during the expired airway mode, the cartridge  22  would not necessarily need to be replaced when changing modes; however, the cartridge  22  may likewise be replaced, if desired, in order to avoid contaminating the condensate collected in one mode with any residual condensate or remaining fluids still present in the cartridge  22  after operation in the first mode. 
     The advantage of this differential sample collection would be the distinction of pathological processes affecting the lining of the bronchial tree versus processes primarily affecting the alveoli. The ability to distinguish lower airway disease (e.g., on the basis of differential measurement of inflammatory markers) from diseases affecting the conducting tract can have important ramifications on treatment. 
     Based on the foregoing information, it is readily understood by those persons skilled in the art that the present invention is susceptible of broad utility and application. Many embodiments and adaptations of the present invention other than those specifically described herein, as well as many variations, modifications, and equivalent arrangements, will be apparent from or reasonably suggested by the present invention and the foregoing descriptions thereof, without departing from the substance or scope of the present invention. Accordingly, while the present invention has been described herein in detail in relation to its preferred embodiment, it is to be understood that this disclosure is only illustrative and exemplary of the present invention and is made merely for the purpose of providing a full and enabling disclosure of the invention. The foregoing disclosure is not intended to be construed to limit the present invention or otherwise exclude any such other embodiments, adaptations, variations, modifications or equivalent arrangements; the present invention being limited only by the claims appended hereto and the equivalents thereof. Although specific terms are employed herein, they are used in a generic and descriptive sense only and not for the purpose of limitation.