Abstract:
Methods and systems are described to obtain and analyze one or more gas samples from the breath of a person, and organizing the samples in a sample registry for subsequent analysis. This technique solves the various problems that are associated with targeting an individual breath for analysis, and allows for additional versatility and options in the analysis process.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of U.S. Provisional Application Nos. 61/763,896 and 61/794,254 filed on Feb. 12, 2013 and Mar. 15, 2013, respectively, the disclosures of which are hereby incorporated by reference in their entireties. 
     
    
     FIELD 
       [0002]    Described herein are devices and methods for the analysis of breath exhalant for diagnostic purposes. More specifically, devices and methods are described for sampling and analyzing a relevant portion of the breathing cycle, for example end-tidal gas, from a person&#39;s breath. The devices and method may be used, for example, to correlate the gas analysis to an underlying physiologic condition for diagnostic, monitoring or screening purposes, or in conjunction with a therapeutic treatment. 
       BACKGROUND 
       [0003]    Certain metabolites and chemicals produced in or entering the body and blood stream are excreted in the breath. The level in the body or blood stream may be determined by measuring it in the breath. For example, breath carbon monoxide (CO) levels may be measured to detect and monitor underlying disorders such as hematological disorders and conditions, metabolic disorders, and environmental and behavioral problems. For example, end-tidal CO can be correlated to blood CO, which can be indicative of hemolysis, smoking or inhalation poisoning. In order to measure end-tidal CO, alveolar gas may be collected non-invasively from the exhaled breath of a patient, by capturing the portion of the breath at the end of exhalation. The captured end-tidal gas can then be analyzed for its CO concentration thus completing the non-invasive measurement. Typically, a correlation exists between the end-tidal gas level and the level of the metabolite or chemical in the body or blood, for example a 1:1 ratio or some other ratio. 
         [0004]    Typically, but not always, two types of sensors are used; a breath monitoring sensor and a gas analysis sensor. For breath monitoring, in order to precisely target and collect the appropriate section of the breathing pattern, typically a real-time or nearly instantaneous sensing technology is used to measuring the breathing pattern, such as an infrared CO 2  sensor. Or other sensors such as airway pressure sensors, flow sensors, oxygen gas sensors, chest impedance sensors, acoustic sensors, vibration sensors, and diaphragmatic movement and innervation sensors. For gas composition analysis, in order to meet the requisite clinical accuracy, the available sensors that meet this purpose typically require a substantial signal response time that is significantly longer than the duration of a single breath. Therefore, in accurate systems, the gas analysis step may take place after the breathing pattern monitoring and gas sample collection step. 
         [0005]    There may be some significant limitations with conventional breath analysis systems. Specifically, in a first limitation it has been reported that due to irregular breathing patterns, obtaining and analyzing a proper end-tidal gas sample is often problematic and in some cases not possible. Determining whether or not a particular breath is a “normal” breath consisting of a valid alveolar gas composition in its exhalation phase, often cannot be determined until after a series of breaths or a substantial duration of breathing is analyzed. “Capnography”, by J. S. Gravenstein, Michael B. Jaffe, Nikolaus Gravenstein describes numerous paradigms where breath analysis would be useful but cannot be completed due to underlying irregularities. Most of the analyses shown in the book assume “artifact free” waveforms, and the authors acknowledge that this is rarely the case, especially in diseased patients, intubated patients, and other commonly occurring clinical events. In addition, clinical trials related to breath analysis typically have to exclude patients with irregular, erratic or unpredictable breathing patterns. Medtronic Capnography brochure MIN 3012492-001/CAT 21300-001569 displays a series of capnographic waveforms all of which routinely occur in clinical settings as a result of disease, airway obstruction, apnea, inadequate breath, etc. Many of these conditions would make detailed measurements of chemical composition of breath difficult, inaccurate, or impossible. Further, as is obvious to anyone skilled in the art, analysis of gases such as CO, H 2  and nitric oxide may be an order of magnitude more complex than the measurement of CO 2  concentration, the subject of most of the references cited above. This means that when CO 2  concentration cannot be reliably obtained, than most probably no other gas concentration measurements can be obtained either. 
         [0006]    In a second limitation, it has been realized that conventional breath gas analysis devices may either miss important information by: (a) measuring only one individual breath, thereby missing potentially very useful information contained in a different breath; or by (b) volumetrically combining all the breaths within a series of breaths in a chamber, thereby diluting the information contained in an important breath. The systems may also be limited in that if measuring all the breaths within a series of breaths, valid and invalid breaths are combined thus potentially diluting the accuracy of the result. 
         [0007]    Several issued U.S. patents and published patent applications discuss state of the art in breath analysis. U.S. Pat. No. 6,544,190 B1 discloses that the system described “provides a means to reject test data when excessive breath variability likely makes the test unreliable.” Medtronic application Ser. No. 11/588,990, publication number US 2008/0009762 A1 describes an algorithm to analyze capnographic data by providing a non-linear fit to the shape of the capnography curve, but does not address any underlying chemical analysis of the breath. Similarly, U.S. Pat. No. 6,428,483 (issued to Oridion) describes a capnographic waveform analysis system which considers angles of the waveform, transition points, and other characteristics, but it operates on one breath at a time, in real time, and has no storage mechanism. Next, U.S. Pat. No. 6,733,463 describes a nitric oxide measurement system which tries to control the exhalation flow rate, but this also is not applicable to breaths with variable flow and rate characteristics. U.S. Pat. No. 8,021,308 describes a method of isolating the end tidal portion of the breath, by finding the transition point between exhalation and inhalation, and then analyzing that portion of the breath, in real time. While that invention has adjustable analysis methodology based on the breath rate, it is limited to identifying a transition point or portion of the current breath (such as end tidal), and it does not provide a means for subsampling the stored volume, or subsequent adaptation of beginning and ending sampling points. Further, it doesn&#39;t provide means for storing multiple full breaths. U.S. Pat. No. 6,582,376 describes a measurement system for alveolar breath analysis, and provides a sample volume to store a portion of the breath based on a threshold, but it does not allow for separate identification of individual breaths. 
       SUMMARY 
       [0008]    Described herein are methods, systems and devices that analyze gases, particles and other substances in the breath by organizing a physical registry of a series of breaths and/or sections from individual and/or multiple breaths, characterizing the breath types and breath section types within that registry, organizing the different segments within that registry, and conducting the desired analysis on the desired breaths and/or desired breath sections, in real time, or after a period of time has elapsed. 
         [0009]    To address the problems associated with conventional state-of-the-art approaches, a more powerful and useful gas analysis technology in some variations employs a breath storage and breath information registry. For example in some variations, the breath analyzer may analyze in detail a series of breaths, and collect multiple samples and subsamples from that series, then after the breathing pattern and breath types of the series are analyzed and the information organized in a registry, the system may either combine the samples together for further analysis, or combine and/or segregate them in different ways for further analysis, or separate them for individual different types of analyzes, all based on a characterization and comparison of the breath types in the series of breaths. 
         [0010]    In a first variation, gas from a breath or series of breaths are drawn from a patient and the breath types and breath section types of each section of gas are defined analyzing using a breathing signal from a breathing sensor, preferably but not always a fast, instantaneous or near-instantaneous breathing sensor, and the requisite algorithms. The breathing signal contains indications of timing markers in a breath cycle, and may, for example, be obtained using IR sensors tuned to a breathing gas type, or multiple gas types, such as in capnography. The breath gas itself may be captured into a sample collection compartment with a small cross-sectional flow path to reduce mixing between constituent sections of gas from different sections of a breath, and between breaths. The different constituent sections may be cataloged in a registry, based on the breathing signal. Desired sections may be analyzed to determine the level of a gas of interest. 
         [0011]    In a second variation, the breath gas is captured into different sample collection compartments each with a small cross-sectional flow path to reduce mixing between constituent sections of gas. The different constituent sections of the different compartments may be cataloged in a registry, using the breathing signal. Desired sections may be analyzed by different sensor types to determine the level of different gases of interest. 
         [0012]    In a third variation, breath gas is captured into a sample collection compartment with a small cross-sectional flow path to reduce mixing between constituent sections of gas. The different constituent sections may be cataloged in a registry. Desired sections may be analyzed by various different sensors to determine the level of various gases in question. 
         [0013]    In a fourth variation, breath gas is captured into different sample collection compartments each with a small cross-sectional flow path to reduce mixing between constituent sections of gas. The different constituent sections of the different compartments may be cataloged in a registry. Desired sections may be analyzed to determine the level of a substrate in question. 
         [0014]    In additional variations, an appropriate gas such as ambient gas or an inert gas is inserted in between different constituent sections of gas in the sample compartment to help separate the sections. In other variations, a particular portion of a breath such as the end-tidal portion, is collected and collated from multiple breaths and analyzed. In other variations, different pneumatic configurations of flow pumps, sample collection compartments and substrate analysis sensors are described. 
         [0015]    In some variations, a breath gas capture device does not include an analysis sensor, and the sample compartment is transported to a sensor after the gas is captured. For example, the gas may be captured at the patient bedside, doctor&#39;s office or remotely at home or in the field, then transported to a laboratory for analysis. In other variations, different sections of the breath may be organized in the registry for appropriate analysis. For example, upper airway analytes may contain the sample of interest, or middle airway analytes, or lower airway analytes, or alveolar analytes, or a combination thereof, depending on the diagnostic test(s) desired. The system can be fully programmable by the user, such that the user can enter the type of analysis to be undertaken, and the system then executes the necessary control systems and algorithms to collect, organize and analyze the necessary samples. In other variations, the test subject may be commanded by the user or the system to perform certain breathing maneuvers while the breath samples are being collected. For example, the user can submit a breath hold, or a deep breath, or a shallow breath, or a normal tidal volume breath, or combinations thereof. This may increase the resolution of the system in cases in which an analyte indicative of the disease in question is most noticeable in a certain breath type. The system may validate and accept or reject each sample based on measuring the actual submitted breath and comparing against expected breathing pattern signals. Or, the test subject may be subjected to a challenge maneuver for example in which he or she is instructed to breathe or inject a tracer element or provoking agent, and in which the resulting analytes in the breath change as a result, indicative of the underlying pathology or disease or syndrome under question. It should be understood that the systems described in this disclosure may include obtaining samples from a non-cooperative subject as well as cooperative subjects. 
         [0016]    In a fifth variation, a breath sampling and analysis apparatus includes: a sensor that detects a gas parameter for determining the start point and end point of different breath portions; a pump that draws at least one gas sample from a person&#39;s breath; and a sample compartment that stores breath portions each in separate physical locations. 
         [0017]    In a sixth variation, the breath analysis apparatus of the fifth variation further includes an analyzer that analyzes separately each of the stored breath portions for a parameter. 
         [0018]    In a seventh variation, the sample compartment of the fifth variation comprises a capillary channel in which the different breath portions occupy sections of volume of the channel, and wherein the sections are end to end. 
         [0019]    In an eighth variation, the separate physical locations of the fifth variation comprises separate sample containers, and wherein the apparatus further comprises a manifold system to divert the different breath portions into the separate sample containers. 
         [0020]    In a ninth variation, the each sample container of the eighth variation comprises a respective bypass tube and a respective sensor. 
         [0021]    In a tenth variation, the each sample container of the eighth variation comprises a respective sensor, and wherein the apparatus comprises one bypass tube for all sample containers. 
         [0022]    In an eleventh variation, the breath analysis apparatus of the eighth variation comprises one sensor for all sample containers and one bypass tube for all sample containers. 
         [0023]    In a twelfth variation, the breath portions of the fifth variation are from a single breath. 
         [0024]    In a thirteenth variation, the breath portions of the fifth variation are from different breaths. 
         [0025]    In a fourteenth variation, the breath analysis apparatus of the fifth variation includes an analyzer that analyzes one or more breath portions for a first parameter. 
         [0026]    In a fifteenth variation, the analyzer of the fourteenth variation analyzes another one or more breath portions for a second parameter. 
         [0027]    In a sixteenth variation, the breath analysis apparatus of the fifth variation includes an analyzer that analyzes the breath portions together. 
         [0028]    In a seventeenth variation, the breath analysis apparatus of the fifth variation includes an analyzer that analyzes the breath portions separately. 
         [0029]    In an eighteenth variation, the breath analysis apparatus of the fifth variation includes a processor to identify a desired breath portion by receiving measurements of a breathing pattern characteristic, and wherein the sample compartment receives gas from the desired portion of the breath. 
         [0030]    In a nineteenth variation, a breath sampling and analysis apparatus includes: a sensor that identifies the beginning and end of a breath, thereby dividing the breath pattern into different breath portions identifying the beginning and end of different breath portions; a vacuum pump that draws a gas sample from a person&#39;s breath into at least one sample tube, the sample tube comprising gas from at least one breath and at least one breath portion; and a computer to identify the location of gas in the sample tube corresponding to the beginning and end of the breath, and corresponding to the beginning and end of the breath portion. 
         [0031]    In a twentieth variation, the breath analysis apparatus of the nineteenth variation includes an analyzer that analyzes the stored breath samples for a parameter. 
         [0032]    In a twenty-first variation, a breath sampling apparatus includes: a sampling tube configured to prevent mixing within the tube of breath exhaled by a patient; an inlet valve and an outlet valve coupled to the sampling tube, wherein the inlet valve and outlet valve together are operable to capture the breath exhaled by the patient within the sampling tube; and an inlet tube fluidly coupled to the sampling tube, wherein the inlet tube is operable to directly receive the breath exhaled by the patient, and wherein the inlet valve is further operable to isolate the sampling tube from the inlet tube. 
         [0033]    In a twenty-second variation, the breath sampling apparatus of the twenty-first variation includes a processor for determining a position in the storage tube of a segment of the exhaled breath. 
         [0034]    In a twenty-third variation, the breath sampling apparatus of the twenty-first variation includes an in-flow sensor for determining one or parameters of the exhaled breath in the sampling tube. 
         [0035]    In a twenty-fourth variation, the in-flow sensor of the twenty-third variation includes one or more selected from the group consisting of a flow rate sensor, a MEMS fluidic sensor, an optical bench, and a mass spectrometer. 
         [0036]    In a twenty-fifth variation, the processor of the twenty-third variation determines the position of the segment by referencing a record of parameters of the exhaled breath in the sampling tube, wherein the record is populated by the one or more parameters determined by the in-flow sensor. 
         [0037]    In a twenty-sixth variation, the one or more parameters of the twenty-fifth variation includes one or more selected from the group consisting of a time profile of the exhaled breath entering the sampling tube, a flow rate profile of the exhaled breath, a pump-speed profile of a pump coupled to the sampling tube, a pressure profile of the exhaled breath, a carbon dioxide concentration profile of the exhaled breath, and a temperature profile of the exhaled breath. 
         [0038]    In a twenty-seventh variation, the breath sampling apparatus of the twenty-first variation includes an analyzing system for determining a characteristic of a segment of the exhaled breath after it is captured in the sampling tube. 
         [0039]    In a twenty-eighth variation, the analyzing system of the twenty-seventh variation includes one or more storage containers, wherein the one or more storage containers are fluidly coupled to the sampling tube, and wherein the outlet valve is operable to isolate the sampling tube from the one or more storage containers. 
         [0040]    In a twenty-ninth variation, the analyzing system of the twenty-seventh variation an exhaust for venting segments of the exhaled breath. 
         [0041]    In a thirtieth variation, the analyzing system of the twenty-seventh variation analyzes a characteristic of one or more gases selected from the group consisting of anesthesia gases, poisonous gases, metabolic gases resulting from alcohol use, metabolic gases resulting from drug use, metabolic gases resulting from disease, and hydrogen. 
         [0042]    In a thirty-first variation, the breath sampling apparatus of the twenty-first variation includes a pump fluidly coupled to the sampling tube, wherein the outlet valve is operable to isolate the sampling tube from the pump. 
         [0043]    In a thirty-second variation, the pump of the thirty-first variation has a variable speed. 
         [0044]    In a thirty-third variation, the pump of the thirty-first variation has a reversible flow direction. 
         [0045]    In a thirty-fourth variation, the sampling tube of the twenty-first variation has a capillary tube. 
         [0046]    In a thirty-fifth variation, the sampling tube of the twenty-first variation is configured to store a plurality of exhaled breaths. 
         [0047]    In a thirty-sixth variation, the plurality of exhaled breaths of the thirty-fifth variation are exhaled by a plurality of patients. 
         [0048]    In a thirty-seventh variation, a method of analyzing one or more breaths includes: storing the one or more breaths in a sampling tube configured to prevent mixing of the breath within the sampling tube; recording one or more characteristics of the breath stored in the sampling tube; identifying one or more segments of the breath stored in the sampling tube, wherein the identification of the one or more segments is based upon the recorded characteristics of the breath; extracting the one or more segments from the sampling tube; and analyzing the one or more segments. 
         [0049]    In a thirty-eighth variation, the recording the one or more characteristics of the breath of thirty-seventh variation includes determining the one or more characteristic with an in-flow sensor. 
         [0050]    In a thirty-ninth variation, the in-flow sensor of the thirty-eighth is configured to determine one or more selected from the group consisting of a time profile of the exhaled breath entering the sampling tube, a flow rate profile of the exhaled breath, a pump-speed profile of a pump coupled to the sampling tube, a pressure profile of the exhaled breath, a carbon dioxide concentration profile of the exhaled breath, and a temperature profile of the exhaled breath. 
         [0051]    In a fortieth variation, the extracting the one or more segments of the breath in the thirty-seventh variation includes exhausting unwanted segments. 
         [0052]    In a forty-first variation, the extracting the one or more segments of the breath in the thirty-seventh variation includes storing the one or more segments in one or more storage containers. 
         [0053]    In a forty-second variation, the extracting the one or more segments of the breath in the thirty-seventh variation includes returning unwanted segments to the sampling tube using a pump with a reversible flow. 
         [0054]    In a forty-third variation, the analyzing the one or more segments of the breath in the thirty-seventh variation includes analyzing a characteristic of one or more gases selected from the group consisting of anesthesia gases, poisonous gases, metabolic gases resulting from alcohol use, metabolic gases resulting from drug use, metabolic gases resulting from disease, and hydrogen. 
         [0055]    In a forty-fourth variation, the analyzing the one or more segments of the breath in the thirty-seventh variation includes analyzing at least one selected from the group consisting of breath segments from a plurality of breaths, an end-tidal concentration of one or more breaths, and an alveolar concentration of one or more breaths. 
         [0056]    In a forty-fifth variation, the storing the one or more breaths in the thirty-seventh variation includes storing the one or more breaths in a capillary tube. 
         [0057]    In a forty-sixth variation, the storing the one or more breaths in the thirty-seventh variation includes storing a plurality of breaths from a plurality of patients. 
         [0058]    In a forty-seventh variation, the storing the one or more breaths in the thirty-seventh variation includes drawing the breath into the sampling tube with a pump. 
         [0059]    In a forty-eighth variation, the pump of the forty seventh-variation has a variable flow rate. 
         [0060]    In a forty-ninth variation, a breath sampling apparatus includes: a sampling tube configured to prevent mixing of exhaled gases within the sampling tube; and first and second valves coupled to the sampling tube, wherein the first and second vales are configured to capture exhaled breath within the sampling tube. 
         [0061]    In a fiftieth variation, a method of analyzing one or more breaths includes: identifying one or more constituent portions of the one or more breaths; storing the one or more breaths so the one or more constituent portions are not mixed; identifying at least one of the one or more constituent portions for analysis; and analyzing the at least one of the one or more constituent portions. 
         [0062]    In a fifty-first variation, a method of analyzing a breaths includes: storing the breath so that one or more constituent portions of the breath are not mixed; and analyzing at least one of the one or more constituent portions. 
         [0063]    Variations disclosed herein may have the following benefits. First, a breath, or multiple breaths, can be physically stored, while preserving accurate timing and breath type information for each breath, and each section of each breath. This allows for any portion of the breath(s) to be independently analyzed for the chemical composition under interest. It also allows for a breath or section of breath to be chosen for analysis after comparing and contrasting its breath type against thresholds and against other breath types in a series of breaths. It also allows for different breath types to be sought and chosen for different types of compositional analyses. Second, variations herein prevent undesired mixing of the breath sample, for example the end-tidal sample, with the ambient or other portions of the breath, or other breaths, by selecting a proper size of the storage apparatus and appropriate isolation valves, pneumatic routing of the gas, and precise valve control. Third, variations herein include adding an inert gas as necessary to maintain relative concentration of gasses of interest. This may be useful when the overall volume of the collected breath is too small to be effectively moved around the apparatus or measured, and also to avoid the mixing in of the ambient air into the stored samples. Fourth, variations herein include varying the gas sampling flow rate to collect incoming breath gas at variable speed, covered in more detail in U.S. patent application Ser. No. 13/722,950, assigned to the assignee of the present application, the disclosure of which is incorporated by reference herein in its entirety. 
         [0064]    Separately, the derivation of the breathing signal can be accomplished using various algorithms for analysis of a breath waveform to determine a breath segmentation to achieve a specific objective: increased volume of specific breath portions, increased accuracy by sampling smaller sections of the breath, end tidal concentration, alveolar concentration, etc. These algorithms may affect the decision making for time markers for one breath which are dependent on the shape and number of one or more additional breaths. This may particularly be the case when a specific breathing pattern is identified, say for a known pathology, for which several breaths needs to be collected. Algorithms for identifying time markers for each of the breaths collected during the sampling period may subsequently be adjusted as new breaths come in. The time markers identified from the breathing signal may then be used to correctly identify breath portions to group together, to obtain sufficient volume to be measurable by the sensors. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0065]      FIG. 1  describes a flow chart of a basic sequence of operation of an analyzer in which segmentation of the breath samples occurs in series with monitoring and capturing of the samples, in accordance with one variation. 
           [0066]      FIG. 2  describes a flow chart of a basic sequence of operation of an analyzer in which segmentation of the breath samples occurs in parallel with monitoring and capturing of the samples, in accordance with one variation. 
           [0067]      FIG. 3  graphically describes a typical breath monitoring waveform based on a carbon dioxide measurement which is taken on the gas being drawn from the breath, in accordance with one variation. 
           [0068]      FIG. 4  graphically describes a typical breath monitoring waveform based on an airway pressure measurement taken at the proximal airway, in accordance with one variation. 
           [0069]      FIG. 5  is a schematic diagram of an exemplary analyzer capable of organizing a registry of separate gas samples, for example for analyzing more than one breath and for more than one substance, in accordance with one variation. 
           [0070]      FIG. 6  describes a capnometry plot of a series of breaths that are considered for analysis by the instrument shown in  FIG. 5 , with three certain breath types sought, identified, captured and analyzed, in accordance with one variation. 
           [0071]      FIG. 7  describes a capnometry plot of another series of breaths that are considered for analysis by the instrument shown in  FIG. 5  with three different types of breaths sought, identified, captured and analyzed, in accordance with one variation. 
           [0072]      FIG. 8  is a schematic diagram of an alternate exemplary analyzer capable of organizing a registry of gas samples from one or multiple breaths, for example for analyzing more than one substance, in accordance with one variation. 
           [0073]      FIG. 9  describes a capnometry plot of a series of breaths that are considered for analysis by the instrument shown in  FIG. 8 , with a certain breath type sought, identified, captured and analyzed, in accordance with one variation. 
           [0074]      FIG. 10   a  describes a pneumatic schematic of the sample collection part of the analyzer described in  FIG. 8 , in which the end-tidal sections of multiple breaths are stored in the sample compartment, in accordance with one variation. 
           [0075]      FIG. 10   b  describes a pneumatic schematic of the sample collection part of the analyzer described in  FIG. 8 , in which the end-tidal sections of multiple breaths are stored in the sample compartment and are separated by inert or non-end-tidal gas, in accordance with one variation. 
           [0076]      FIG. 11  is a schematic diagram of an alternate exemplary analyzer capable of organizing a registry of gas samples from one or multiple breaths in separate sample compartments, for example for choosing the most optimal sample for analysis, or comparison of the different samples, in accordance with one variation. 
           [0077]      FIG. 12  describes a capnometry plot of a series of breaths that are considered for analysis by the instrument shown in  FIG. 11 , with a certain breath type sought, identified and captured, and then compared for analysis, in accordance with one variation. 
           [0078]      FIG. 13  is a schematic diagram of an alternate exemplary analyzer capable of organizing a registry of gas samples from one or multiple breaths in separate sample compartments, for example for choosing the most optimal portion of the sample for analysis, in accordance with one variation. 
           [0079]      FIG. 14  describes a capnometry plot of a series of breaths that are considered for analysis by the instrument shown in  FIG. 13 , with a certain breath type sought, identified and located in the sample registry, in accordance with one variation. 
           [0080]      FIG. 15  describes a pneumatic schematic of the sample collection part of the analyzer described in  FIG. 13 , in which the end-tidal sections of multiple breaths are stored and organized in the sample compartment, in accordance with one variation. 
           [0081]      FIG. 16  describes a capnometry plot of a series of breaths that are considered for analysis by the instrument shown in  FIG. 13 , with breath types, identified and located in the sample registry for subsequent analysis, in accordance with one variation. 
           [0082]      FIG. 17  describes a pneumatic schematic of the sample of the breaths described in  FIG. 16 , in which multiple breaths including their end-tidal sections are stored and organized in the sample compartment, in accordance with one variation. 
           [0083]      FIG. 18  is a pneumatic schematic describing an example of the breath gas sample collection and segmentation, considering the breath series shown in  FIG. 16 , in accordance with one variation. 
           [0084]      FIG. 19  describes the example in  FIG. 18  with chosen sections of chosen breaths shuttled to a secondary storage sample tube where it is staged for subsequent compositional analysis, in accordance with one variation. 
           [0085]      FIG. 20  is a pneumatic schematic describing an example of a system with an in-series sample tube, pump, secondary sample staging tube and compositional sensor, with sections of breath gas organized in the sample tube, considering the breath series shown in  FIG. 16 , in accordance with one variation. 
           [0086]      FIG. 21  describes the example in  FIG. 20  with chosen sections of chosen breaths shuttled to a secondary sample staging tube where it is staged for subsequent compositional analysis, in accordance with one variation. 
           [0087]      FIG. 22  describes an alternative configuration to the system described in  FIG. 20  in which the breath gas is forced into the sample tube by another means, such as from the patient&#39;s exhaled flow, and then the sample gas is pumped to the staging tube and/or sensor by use of a pump, in accordance with one variation. 
           [0088]      FIG. 23  is a pneumatic schematic describing an alternate configuration of the apparatus with a sample tube, bypass tube, sample push tube, secondary staging tube, and a delay tube to provide time to categorize a breath or breath section to determine if it should be captured or purged, in accordance with one variation. 
           [0089]      FIG. 24  is a pneumatic schematic describing an alternate configuration of the apparatus with multiple gas composition analyzers and associated sample staging tubes, and with a delay tube to provide time to categorize a breath or breath section to determine if it should be captured or purged, in accordance with one variation. 
           [0090]      FIG. 25  is a pneumatic schematic describing an example of a system similar to that described in  FIG. 20 , however with multiple gas composition analyzers and associated secondary storage tubes, in accordance with one variation. 
           [0091]      FIG. 26  shows the system described in  FIG. 25  with samples transported from the sample tube to the secondary staging tubes, in accordance with one variation. 
           [0092]      FIG. 27  is a timing diagram of a version of the overall system, showing the timing of different types of breaths superimposed with the sample storage tube, in accordance with one variation. 
           [0093]      FIG. 28  is a pneumatic schematic describing an alternative configuration to the system described in  FIG. 24  in which a pump draws the sample from the patient and propels the sample to various sample tubes and substrate composition sensors, wherein the pump may be a peristaltic type pump so that the organization of the gas constituents in the gas path is not disrupted by the pump, in accordance with one variation. 
       
    
    
     DETAILED DESCRIPTION 
       [0094]    Described here are devices and methods for creating a breath gas sample registry, and analyzing the gas in that registry for a desired monitoring, screening or diagnostic purpose. In the embodiments shown, for exemplary purposes, the patient&#39;s breath sample is shown to be drawn into the instrument from the patient by application of vacuum. However the disclosure also applies to patients breathing into the instrument in order for the instrument to collect the breath sample, without the vacuum application. 
         [0095]    In some variations, one or more breathing parameters are measured to identify the different constituent portions of a breath and the respective time periods, and a pneumatic system is used for capturing the portion of exhaled breath in a sampling tube using the identified time period. In some variations, one or more valves and/or flow control mechanisms—such as a vacuum pump, for example—are used to regulate the flow rate of gas drawn into the sampling tube. In some variations, the captured portion of breath is analyzed for indications of a patient&#39;s physiological state. 
         [0096]    Measured breathing parameters may include one or more of carbon dioxide, oxygen, airway pressure, airway temperature, breath flow rate, chest impedance, diaphragmatic movement or innervation, breath sounds, or breath vibrations. Identifying the time period of a portion of a breath may include identifying substantially the start, midpoint and termination of that time period. 
         [0097]    A diagnostic gas sample may be best taken from the end-tidal period, for example when attempting to diagnose a physiologic condition in the blood stream, such as hemolysis. For explanatory purposes, exemplary variations for sampling end-tidal gas for end-tidal CO measurement are given below; however the principles apply to other diagnostic purposes. 
         [0098]      FIG. 1  describes the basic sequence of operation of the device, in accordance with one variation. The first module or algorithm  100  performs the breath monitoring and detection function. In this module, the breathing pattern of a person is monitored, typically with an instantaneous or near-instantaneous sensor. The breathing pattern information provides all the relevant and useful information about the breaths and sections of breaths over a series of breaths. The information is used for categorizing and typifying breaths and sections of breaths, and is time based to define the timing associated with the different breaths and sections of breaths. The second module or algorithm  104  performs the breath sample capturing function, which can take place in parallel with the breath monitoring and detection module. In this module, the collected gas is segmented into its constituent parts, and the constituent parts are physically separated, or identified with a time or location identification. The third module or algorithm  106  performs breath type characterization, based on information from the breath monitoring and detection module, and catalogs each breath and each section of each breath into a registry along with relevant information regarding each breath and section. The characterization may be made using criteria that may be predefined, or defined in real-time, or user-defined, automatically defined or semi-automatically defined. For example, predefined criteria may be absolute or relative threshold parameters stored in the device&#39;s software. Or a user may enter certain information relative to the specific test being performed, and the system may use that information to define the criteria. Or the system can automatically establish the criteria in real time based on the prevailing conditions, or for a known or identified patient pathology, where certain breath patterns may be more likely to occur. Or a combination of the above techniques can be employed. In this module, the software algorithms decide which breath or breaths, or which section of breath or breaths, will be analyzed and for what analysis. Finally in a fourth module or algorithm  108 , the sample or samples are transferred from its storage location to the associated sensor for compositional analysis or analyses. 
         [0099]      FIG. 2  schematically describes an alternate sequence of operation of the device in which modules  100 ,  104  and  106  may occur in parallel, or substantially in parallel, or partially in parallel, in accordance with one variation. 
         [0100]      FIG. 3  graphically describes a typical breathing pattern from the perspective of a carbon dioxide (CO 2 ) signal measured in breath drawn from the person&#39;s airway, such as from their nose, as a function of time, with time t on the horizontal axis, and CO 2  level  50  on the vertical axis, in accordance with one variation. During the expiratory phase E CO 2  is expelled, hence the CO 2  level increases. During the inspiratory phase I ambient air occupies the nose, hence the measured CO 2  drops to essentially zero. There may be a variety of shapes to a breath CO 2  curve, based on the person&#39;s breathing pattern, their age, how they are breathing and any underlying acute or chronic medical conditions. A classic curve may show the following sub-portions for the expiratory phase: (1) a beginning portion of pre-end-tidal gas PETG, containing low or no CO 2  because the gas may simply be gas from the proximal airway devoid of CO 2 , (2) a middle portion of pre-end-tidal gas PETG, containing CO 2  rapidly increasing from zero to the CO 2  level at the distal segments of the lungs, and (3) an end-portion of end-tidal gas ETG showing a plateauing or leveling off of the CO 2 , representing the CO 2  coming from the alveoli for that exhaled breath, and (4) potentially a constant peak level at the very end of the expiratory period, and (5) an inspiratory section of inspiratory gas (IG). However, there can be many other curves different from this classic curve. Peak CO 2  levels are typically 4-6% during the end-tidal period and close to or equal to zero during the inspiratory period. 
         [0101]    In some variations, the level of CO 2  in an exhaled breath is used to determine the duration of a period of a breath. In further variations, duration of a period of breath may be characterized by a start and a termination of that period. In some variations, a CO 2  level is used to determine a start or a termination of a period of a breath. Some examples include inspiratory time Ti, expiratory time Te, pre-end-tidal time Tpet, end-tidal time Tet, post expiratory time Tpe. In other variations, a first time derivative of a CO 2  level is used to determine a start or a termination of a period of a breath. In yet other variations, a second time derivative of a CO 2  level is used to determine a start or a termination of a period of a breath. In some variations, a combination of CO 2  levels and CO 2  level time derivatives may be used to determine a start or a termination of a period of a breath. In some variations, a start of an end-tidal period may be determined by a change in the first time derivative of a CO 2  level of the exhaled breath, such as a sudden decrease in the first time derivative of the CO 2  level. In some variations, a decrease in the first time derivate of the CO 2  level is more than a 10% decrease. In some variations, a decrease in the first time derivate of the CO 2  level is more than a 25% decrease. In some variations, the derivative will approach or become zero showing very little rate of change or a peak plateau respectively. In other variations, the start of an end-tidal period may be determined by a large second time derivative of the CO 2  level. In some variations, a termination of an end-tidal period may be determined by a maximum CO 2  level, which may be detected or confirmed by a change in the sign of the first time derivative of the CO 2  level as the derivative becomes negative associated with a drop of the CO 2  level from its peak value. In further variations, a start of a beginning period may be determined by a sudden increase in the first time derivative of the CO 2  level. In other variations, the start of a beginning period may be determined by an increase in the CO 2  level from zero CO 2  level. In some variations, a termination of a middle period may be determined by a change in the first time derivative of a CO 2  level of the exhaled breath, such as a sudden decrease in the first time derivative of the CO 2  level. In some variations, a CO 2  level, first time derivative thereof, or second time derivative thereof may be used to determine the start and termination of one or more periods. In another variation, a pattern matching algorithm may be employed to analyze the shape of the CO 2  waveform. Other breath-borne gases may be used in place of CO 2  for measuring the breathing curve. For example, oxygen can be measured which would indicate a higher oxygen concentration during inspiration than expiration. It is also contemplated that the breathing pattern may be instantaneously or substantially instantaneously measured by a fast-responding CO sensor. In this case referring to  FIG. 1 , the sensor  10  may be a fast responding CO sensor that depicts the breathing pattern and also measures the end-tidal CO level. After application of the various breath qualification and disqualification variations described subsequently, the CO level of a qualified breath can be reported as the result. 
         [0102]      FIG. 4  graphically describes a typical breathing signal from the perspective of measured airway pressure with airway pressure  74  on the vertical axis and time t on the horizontal axis, in accordance with one variation. The airway pressure shows a negative pressure during inspiratory phase and a positive pressure during expiratory phase. Typically during at rest breathing the peak expiratory pressure may correspond to the middle of the expiratory phase and the start of the end-tidal period. In  FIGS. 3 and 4 , TI, TE, TPET, TET, TPE represent inspiratory time, expiratory time, pre-end-tidal time, end-tidal time, and post expiratory time respectively. An inspiratory pause may also be present (not shown), in which the peak of lung muscle movement during inspiration is paused before the expiratory period begins. Peak inspiratory pressure may be −1 to −4 cwp during restful breathing, and up to −15 cwp during heavier breathing, and peak expiratory pressure may be +0.5 to +2.0 cwp during restful breathing and up to +10 cwp during heavier breathing when measured at the entrance to the nostrils. Airway pressure can be measured with a secondary lumen in the sampling cannula, extending the length of the cannula, or can be measured by teeing into the sampling cannula or by placing a sensing transducer at the airway of the patient. 
         [0103]    In some variations, airway pressure is used to determine a start or a termination of a period of a breath. In other variations, a first time derivative of an airway pressure is used to determine a start or a termination of a period of a breath. In yet other variations, a second time derivative of an airway pressure is used to determine a start or a termination of a period of a breath. In some variations, a combination of airway pressures and airway pressure time derivatives may be used to determine a start or a termination of a period of a breath. In some variations, a start of an end-tidal period is determined by maximum airway pressure, that is, by a zero first time derivative of the airway pressure. In some variations, a termination of an end-tidal period may be determined by zero airway pressure. In some variations, an airway pressure, first time derivative thereof, or second time derivative thereof may be used to determine the start and termination of one or more periods. In some variations, a pattern matching algorithm can be utilized to identify relevant time markers of the breaths. 
         [0104]    In some variations, the breath sensor monitors the person&#39;s breathing over time, and trends the breathing pattern by determining a continually updated value that is characteristic of the breathing pattern. For example, peak positive values of a breathing signal may be measured and updated for each breath. Peak values may be compared with previous peak values. Peak values may be averaged over a previous number of multiple breaths. Similarly, time-related aspects of the breaths may be trended, such as the expiratory time. Various breath-related events that are not normal breaths may be identified and exception algorithms may exist in order to not include these non-normal breath events inadvertently in deterministic steps. For example, the characteristic waveform of a sneeze, cough, stacked breath, or non-full breath may be defined in advanced or based on monitoring of a particular patient, and when detected by the breathing sensor, excepted from the appropriate deterministic algorithms. 
         [0105]      FIG. 5  describes schematically one variation of a device for capturing exhaled breath, with multiple sample collection tubes and multiple sample composition analyzers. Pneumatic flow paths  314 , pneumatic connections  316  and electrical connections  318  are shown. The system includes a sampling cannula  1  and a sample collection and analysis instrument  2 . Gas may be drawn from the patient Pt, for example using a sampling cannula  1  and a flow generator  12 . The flow rate of the flow generator may be measured by a flow transducer, for example a pressure sensor array,  16  and  28 , arranged like a pneumotach. The measured flow rate may be used as a closed loop feedback control to control the flow generator flow rate. A breath sensor, such as a capnometer  10  or a pressure sensor  16 , is used to measure the breathing pattern in real time. Gas or analytes from the desired portions of the breath or from multiple breaths, for example from breath A′, B′ and C′ shown in  FIG. 6 , are captured and isolated in the storage collection compartments A, B and C. Gas entering the storage compartments is controlled by at least one valve such as the compartment inlet valves for compartments A, B and C using VA1, VB1, and VC1 respectively. For example as shown with Valve VA1 a common port c is always open, and the outlet port is either at “a” to collect and isolate the gas in the storage compartment, or at “b” to bypass the storage compartment. Gas not being captured for analysis is channeled away from the storage compartment via bypass conduits  1000 ,  2000  and  3000 . The captured gas is sent from the storage compartment A, B or C through gas composition analyzers, SA, SB and SC, such as CO sensors, and H2 sensors, NO sensors, and other gas and non-gas sensors. There may be storage compartment outlet valves VA2, VB2 and VC2 which are controlled to further isolate the sample compartments, and valves VA3, VB3 and VC3 between gas analyzers SA, SB and SC and the flow generator  12  that are used to either channel the gas being purged, or drawing the captured samples through the gas analyzers. A control system  22  with a microprocessor  24  controls the system with the associated algorithms and a user interface  30  allows the user to interact with the system. An ambient inlet  32  is provided to purge the system of unwanted gases, or for reference measurements. An inlet valve Vi is provided to control the gas inlet source. The flow generator can be a vacuum or pressure pump, such as a diaphragm pump, or another type of flow generating device such as a vacuum source, a Venturi from a positive pressure source, or a syringe pump. Valves to manage gas routing can be an arrangement of 3 way 2 position valves as shown, or can be an arrangement of 4 way 3 position valves. A capnometer if used measures the breathing pattern instantaneously using infrared (IR). Or an IR sensor can be tuned for other gases or multiple gas types such as O2. Some examples of the gas or analyte composition analyzers are electrochemical sensors with reaction times, gas chromatographers, mass spectrometers, or fast response time sensors such as IR. The sample storage compartment can be a small bore inner diameter tube or conduit of relatively long length in order to reduce the cross section which reduces gas molecule interaction along the length of the conduit. The sampling cannula may be constructed of any non-rigid kink-resistant plastic, such as a thermoset plastic for example silicone, urethane or urethane blends, or such as a thermoplastic for example PVC, C-FLEX. Other materials could also be used and the foregoing list should be read to be exemplary and not limiting. The cannula can have a range of inner diameters and in some variations the cannula has a diameter of less than 0.080 inches in order for the breath gas to conform to columnar behavior with definable boundaries between breath sections where mixing across sections may be reduced. In some variations, the inner diameter is between 0.20 inches and 0.50 inches, including 0.25 inches, 0.30 inches, 0.35 inches, 0.40 inches, and 0.45 inches. In other variations, the inner diameter may be different than the foregoing dimensions but configured to prevent mixing of gas. In alternate embodiments, rather than a sampling cannula, a mouthpiece or other conduit can be provided. 
         [0106]    As used herein, a sample compartment “prevents mixing” of a gas when the time-sensitive characteristics of the gas are preserved when the gas is stored in the compartment. For example, if a parameter of the gas varies during exhalation, the sample compartment prevents mixing when it preserves the variance in the parameter with respect to the associated timing of the exhalation. In this way, the sampling tube can be considered to retain the gas sections in separate physical locations. However, the term “separate physical locations” is not limited to such sample compartments. As described below, separate physical locations could include separate sampling containers. In this way, a location of a gas portion may be its position within a sampling compartment configured to prevent mixing or the separate sampling container in which it is stored. 
         [0107]      FIG. 6  graphically describes a breathing parameter signal versus time t, for example capnometry  50 , for a sequence of breaths b1 through b24 being monitored by the system, in accordance with one variation. In this example, the system is looking to capture and analyze normal breaths representative of the patient&#39;s normal tidal volume. Breath type threshold values may be established, such as a breathing signal tidal volume peak value  301 , and a tidal volume baseline value  302 . For example, a normal tidal volume breath may be determined by comparing the actual peak signal amplitude or a breath to the threshold  301 , and within a certain percentage, for example 10%, then it may be classified as a normal tidal volume breath. Duration thresholds may also be used to select breaths, such as inspiratory time Ti, breath period time Tbp, expiratory time Te or end-tidal time Tet, shown in breath b13 in the example as  306 ,  304 ,  308  and  310  respectively. The thresholds may be determined in advance, or during the test. In the example shown, the patient is breathing somewhat erratically between breaths b2 and b15 in that the breath amplitudes and baselines are inconsistent. Thresholds may be determined for one or more frequency parameters, one or more amplitude parameters and one or more return baseline parameters. If breaths are not meeting these criteria, as determined by Module 3  106  of  FIG. 1 , they may be dismissed for analysis. In the example shown, the end-tidal samples A′, B′ and C′ of breaths 17, 18 and 19, meet the criteria set by the system and these breaths are then designated as samples that will be analyzed. 
         [0108]      FIG. 7  graphically describes another sequence of breaths b1 through b19 over time, in accordance with one variation. In this series, various artifacts and odd breath types are exemplified. Between breaths b1 and b3, high frequency noise occurs on the breathing signal. Between breaths b3 and b7 breath stacking occurs. Breath b11 is a partial breath, and breath b14 is a larger than normal breath. In this exemplary case, three different analyses are desired: a first analysis in which end tidal gas following an inspiratory hold is desired for that particular analysis, a second analysis in which end tidal gas from a deeper than normal breath is desired for that analysis, and a third analysis in which a normal tidal volume breath in the midst of stead-state breathing conditions is desired for that analysis. Breaths b9, b14 and b17 are selected for these three analyses respectively and samples A′, B′ and C′ from these breaths are captured by the system. The breath registry database contains all the necessary information which is used in the breath analysis module to shuttle the appropriate gas samples to the sample compartments such as A, B and C, and the appropriate sensors SA, SB and SC in  FIG. 5 . 
         [0109]      FIG. 8  is a system diagram of a version of breath sample analysis registry system  102  with one sample tube and multiple sensors, in accordance with one variation. The system includes one sample tube  18  used to collect the sample or samples, a sensor array of more than one sensor and/or different types of sensors, SA, SB, SC, a bypass tube  20  to allow unwanted gas to bypass the gas in the sample tube, and a push tube  21  to push the sample to the appropriate sensor. Gas from the patient is drawn in by a cannula  1 , or by another type of conduit, and ambient air is drawn in through conduit  32  for system purging or reference measurements. An inert gas reservoir  510  may be included to separate gas samples or for reference measurements. A calibration gas or substance, not shown, may also be included. An additional sensor  26  may be included to measure the gas flow rate, or as a redundant breathing signal sensor. Unneeded gas may be exhausted out of port  33 , and analyzed gas may be exhausted out of ports  29 . In this example, gas from various breaths, or particular sections of various breaths, or various sections of one or more breaths, is captured in the sample tube. The location of each sample within the sample tube is known from the signal of the breathing pattern sensor  10  and optionally sensor  26 , the flow speed of the gas throughout the system, and system timing details. After review of the breath registry information, the system decides what samples to analyze, and knowing exactly where these samples are located, is able to shuttle the samples to the desired sensor. 
         [0110]      FIG. 9  graphically describes a series of breaths b1 through b19 over time, based on a breath signal parameter such as capnometry, in accordance with one variation. If, for example, the system described in  FIG. 8  is selected to analyze three different substrates in the end-tidal gas in normal tidal volume breaths, the sample capture algorithms collect the end-tidal samples A′, B′, C′, D′, E′, and F′ of breaths b8, b10, b13, b16, b17 and b18 and shuttle the collected samples to the individual sensors. 
         [0111]      FIG. 10   a  describes a pneumatic schematic of the sample tube  18  shown in  FIG. 8 , considering the series of breaths shown in  FIG. 9 , in accordance with one variation. The end-tidal samples A′, B′, C′, D′, E′ and F′ are captured in the sample tube, with their locations known. Then, for example, samples A′ and B′ are shuttled to sensor SA for a first substance analysis, samples C′ and D′ are shuttled to sensor SB for a second substance analysis, and samples E′ and F′ are shuttled to sensor SC for a third substance analysis. While three analyses, two end-tidal samples per analysis, and normal tidal volume breaths are described in this example, they are exemplary only and any number of analyses, and number of samples per analysis and any section of breath, and any type of breath is contemplated.  FIG. 10   b  describes an alternative to the example in  FIG. 10   a , in which a gas AG, such as an inert gas like N2, or a gas without the substance undergoing analysis, such as ambient air, is inserted into the sample tube in between samples, in order to help keep the samples separate, in accordance with one variation. This optional variation can be employed through the alternative systems shown throughout this specification. 
         [0112]      FIG. 11  is a schematic of an alternate breath analysis registry system  402  consisting of multiple sample tubes X, Y and Z, and one gas composition sensor  14 , in accordance with one variation. Gas from different breaths, or from different portions of one or more breaths, are captured into the sample tubes X, Y and Z. The constituent gas sections in each sample tube are known. The samples in the sample tubes are isolated by inlet and outlet valves VX1, VY1, VZ1, VX2, VY2 and VZ2 respectively. The inlet to the composition sensor  14  is controlled by valve V11 which may exhaust unwanted gas through port  33  or present gas or analytes to sensor  14 . Gas that the system does not want to capture or analyze may bypass the sample tubes through the bypass tube  20 . After the samples are captured and isolated, and after the breath type and location information is completely logged into the registry, the samples can be shuttled to the sensor for analysis by switching the valves and pushing the sample with ambient air drawn in through the ambient port  32 , through the bypass tube  20 , through the pump  12  and through the push tube  21 , to propel for example the sample in compartment X to the sensor  14 . Each sample in each sample tube can be analyzed by the sensor in a similar manner. The samples can be taken from three similar breaths for comparison and averaging, or from different types of breaths for different diagnostic purposes. 
         [0113]      FIG. 12  shows a series of breaths b1 through b11 that is considered for analysis by the system in  FIG. 11 , in accordance with one variation. In this case, end-tidal gas from three normal breaths are sought for analysis, resulting in capturing samples X′, Y′ and Z′ from breaths b4, b8 and b10, which will be registered in sample compartments X, Y and Z respectively in  FIG. 11 . The system can alternatively be programmed for other sampling and analyses. 
         [0114]      FIG. 13  is a schematic of an alternative breath analysis registry system  504  consisting of one sample tube  18  and one compositional sensor  14 , in accordance with one variation. Gas from a breath or series of breaths is stored in the sample tube  18 . Gas that the system does not want to store bypasses the storage tube through the bypass tube  20  and out the exhaust port  27 . As explained previously, the gas stored in the sample tube is characterized in the sample registry in terms of breath type, breath section, and location in the sample tube. In one implementation of this system indicated in  FIGS. 14 and 15 , end-tidal samples of selected breaths that meet a criterion from a series of breaths are collected in the sample tube, in accordance with one variation. For example, the end-tidal portion of breaths b2, b3, b7, b8, b9, b10, b13, b14, b15, b16, b17 and b18 meet certain initial criteria and are captured in the sample tube  18 , creating the registry of samples  19 . Other sections of these breaths, and other breaths in their entirety are purged through the system through the bypass tube  20 . After analysis of the entire series of breaths, it may for example be decided that the end-tidal sample from breath b18 will be chosen for analysis, and the sample tube gas is pushed by ambient air in the push tube  21  from the ambient inlet  32 , the gas that is dismissed for analysis is purged through the system through the purge exhaust port  33 , and sample from breath b18 is sent through the composition sensor  14 . Alternatively, all of the samples collected in the sample tube can be sent to the sensor  14  for analysis. In another implementation of the system of  FIG. 13 , all breaths from a series of breaths B1 through B10 can be stored in the sample tube as described in  FIGS. 16 and 17 . In  FIG. 16 , the series of breaths is characterized by a capnometry sensor in the top graph, and an airway pressure sensor in the lower graph, such that the type of each breath can be fully and accurately characterized, and so the constituent parts of each breath can be precisely defined as a function of time, and then as a function of location in the sample tube, in accordance with one variation. In  FIG. 17  the sample tube of the system of  FIG. 13  is shown schematically, in accordance with one variation. As shown in  FIG. 17 , the location of each breath portion of each breath B9 through B1 may be known in the sample tube based on the available information as previously described. Based on the breath type information in the registry  19 , the system algorithms decide on which breath section of which breath will be chosen for analysis, at which time the unwanted gas is purged out of the system through port  33  and the chosen section is shuttled to the gas composition sensor  14 . In some embodiments, additional storage can be provided at the output of the purge port, to allow forward and backward shuffling for subsequent re-sampling. 
         [0115]      FIGS. 18 and 19  describes a variant in which there is a first sample tube and a secondary area for sample staging between valves V4 and V5. In this configuration, multiple sequential breaths can be stored in the primary sample tube  18  as shown in  FIG. 18 , and then, based on the registry information and system algorithms, the desired sections, such as the end-tidal sections, of various breaths are shuttled by ambient air in the push tube  21  to the secondary staging tube between valves V4 and V5 while the other gas is purged out of the system at port b of valve V4. The gas sections chosen for analysis after being staged in the secondary tube are shown in  FIG. 19  and include samples from breaths B4, B6, B7 and B8, which are then shuttled to the composition sensor  14  for analysis. The other sample B5, which is rejected for analysis may be exhausted out of port b of valve V4. 
         [0116]      FIGS. 20 and 21  describe a variant in which there is a first sample tube  18  and a secondary tube for sample staging between valves V4 and V5. In this configuration, multiple complete breaths such as a series of sequential breaths can be stored in the primary sample tube as shown in  FIG. 20 , and then, based on the registry information and system algorithms, the desired sections such as end-tidal sections of various breaths are shuttled by ambient air coming in through valve Vi, out of the sample tube and to the secondary staging tube between valves V4 and V5, while the other gas is purged out of the system at port a of valve V4. The gas sections chosen for analysis after being staged in the secondary tube as shown in  FIG. 21  as the end-tidal sections of breaths B1, B2 and B3, are then shuttled to the composition sensor  14  for analysis. While the analyzing the end-tidal sample is again shown in this example, it should be noted that again this is exemplary and the breath section desired to be measured can be anywhere within the breathing cycle, as necessary to measure the most relevant portion of a breath for diagnosing the underlying condition of interest. While the systems in  FIGS. 18 and 20  describe the use of a pump to draw the sample from the patient, alternatively as shown in  FIG. 22 , the breath samples B1, B2 and B3 can be presented into the sample tube  18  via the force of exhalation from the patient pt, in accordance with one variation. Then, after the sample collection and registry routines are performed, a pump  12  can shuttle the gas samples B1, B2 and B3 either out of the purge port a of V4 or to the staging tube between V4 and V5 and ultimately to the sensor  14 . 
         [0117]      FIG. 23  describes a variant in which end-tidal gas samples from breaths are routed into the sample tube  18  while other sections of the breaths are routed around the sample tube through the bypass tube  20 . Again, based on the registry information and system algorithms, samples that are chosen to be discarded are shuttled by ambient air in the push tube  21 , drawn in from Vi, through the purge port b of valve V4, while the chosen sample or samples are shuttled to the secondary tube between V4 and V5, and ultimately to the composition sensor  14 . In the example shown, there may be a delay tube  510  positioned between the breathing signal sensor  10  and the sample tube inlet valve V1, such that the system&#39;s algorithms has sufficient time to decide whether to collect the breath sample in the sample tube  18 , or discard the sample through the bypass tube  20 . In the example shown end-tidal samples from breaths B4, B5 and B8 are collected for measurement and the other breaths are discarded. 
         [0118]      FIG. 24  describes a variant in which end-tidal samples from selected breaths, based on the breath registry information, are stored in one or more sample tubes while breaths or portions of breaths are purged through port a of valve V8. For example, a breath section will be transferred to the compartment between valves V4 and V5 for CO analysis by sensor SCO, another breath section is transferred to the compartment between valves V6 and V7 for H2 analysis by sensor SH2, and another breath section is transferred to the storage tube between valves V8 and V9 for analysis of some other analyte by sensor SO. Pre-sensor filters  512  may be provided before one or more compositional sensors to filter the gas from an interfering compound prior to compositional analysis. Such filters may filter out aldehydes, alcohols, keytones, hydrogen or other interfering substances. In this example a delay tube  510  is included such that there is sufficient time to analyze the breath type information, and time to query the information in the breath registry, before a decision can be made to discard or keep the sample and to decide which compositional sensor a kept sample should be routed to. Typically the delay tube introduces 1-10 seconds. Alternatively, the delay tube can introduce a delay of up to 60 seconds such that information from many breaths is cataloged in the registry, in this case inside the delay tube  510 , before a decision is made to analyze or discard the sample. 
         [0119]      FIGS. 25 and 26  describes a variant in which gas from a series of multiple breaths are drawn into a sample tube  18  and a sample registry is created, then sections of the breaths, for example the end-tidal sections are shuttled to secondary storage tubes and ultimately to the compositional sensors, while the remaining gas is purged out of port a of valve V8, in accordance with one variation. Specifically, breaths B1, B2 and B3 in their entirety enter the sample tube  18  and are cataloged into the registry. When the system determines the course of action for analysis, the required sections of the selected breaths are shuttled to the sensors SCO, SH2 and SO. The samples may be stored in the secondary storage compartments between valves V4 and V5, V6 and V7, and V8 and V9 if necessary to conduct the compositional analysis, such as would be the case if sections of multiple breaths need to be collected and stored prior to analysis, such as would be the case if a minimum volume was needed, or if averaging over multiple breaths was desired. 
         [0120]      FIG. 27  shows a variation with the timing tracings of different types of breaths superimposed below a pneumatic schematic of the sample storage tube. This figure shows one implementation of a system with storage volume, three valves and pump, plus a hypothetical series of types of breath waveforms based on CO2 concentration in the top tracing. Similar waveforms can be obtained by measuring instantaneous flow rate, pressure, or by other means. Some information may be stored together with the physical storage of the breath, that allows later identification of breath portions. The composite hypothetical breath comprises eight distinct breath types. Breath b1 (with label x) might represent a normal healthy breath. Breath b2 (with label y) might represent asthma breath, or other breathing disorder. Between breath b2 and breath b3 there may be a short burst of non-breath activity, which may not be considered. Breath b3 has a significantly lower amplitude, which may be a result of dramatically lowered circulation and low breath volume. Breaths b4, b5, b6 and b7 may represent hyperventilation with shallow and fast breathing. Finally, the last breath b8 (with label z), might be a result of the breath following an apnea event, with very different underlying gas concentrations from normal breathing. Exhaled gas can be stored in the storage volume without a pump, or by using a pump. Valve V1 opens the inlet to the storage volume. Valve V2 closes the outlet of the storage volume. The length of the storage volume tube is dependent on the number of breaths that need to be collected for a given clinical paradigm. The volume, inner diameter and length of storage volume without using a pump is limited, and will produce distortion of breath waveforms and increase gas mixing. However, this may be an acceptable loss of accuracy if the sample must be taken where the pump cannot be operated, or if multiple samples must be collected from multiple patients in parallel and analyzed sequentially (as may be the case in a mass emergency situation). The following description includes the pump operating during the sample collection period, but it should be understood that pump operation is not necessarily coupled with sample collection. When the patient breaths into the storage tube, the pump helps draw the exhaled breath into the sample volume. The pump speed can be selected to match the anticipated breath rate, and can be varied in response to changes in breath rate. After the sample is collected, the combination of Valve V3 and pump operation (accompanied by Valve V1 and Valve V2 to allow air or inert gas inlet and flow from storage sample) is used to selectively choose relevant portions of the stored breaths. Valve V3 is a three-way valve, with one outlet connected to an exhaust (or other storage for subsequent analysis), and the second outlet connected to a series of sensors, as described in  FIG. 28 . A computer driven algorithm may selectively turn Valve V3 from “exhaust” to “analysis” at a rate that would allow sharp segmentation of the underlying stored waveform. 
         [0121]    Some examples of analyses are shown in  FIG. 27 , and will be described as follows. Analysis AA: If one of the main objectives of the measurement is to optimize the volume of end tidal breath to be analyzed (such as in measuring H2 concentration), then relevant sections of the end tidal breath might be grouped together, such as from breaths b1 and b2, labeled x and y. The last section of the hypothetical breath b8 (to the right, labeled z), that may be a result of apnea or another clinical condition, which would not normally be considered in the analysis might need to be included to increase the overall gas volume available for measurement, at the expense of some of the accuracy. The accuracy might be reduced by introducing portion z of the breath, since more than the end-tidal portion is considered, and the breath is not stable with expected concentrations, since it may be an apnea-related breath, with exaggerated CO2 and CO content. Analysis BB: If one of the main objectives of the measurement is to optimize accuracy, then breaths b1, b2 and b3 will be considered, but breath b8 may not, since the first three may have more stable concentrations of gases under investigation. This may be the case when measuring end tidal CO concentration, where parts-per-million accuracy is desired. Any breath conforming to minimal quality criteria would be used, with a shorter portion it, even if its entire end-tidal portion was less than ideal. The algorithm would decide how much of what breath to include in the analysis. Analysis CC: It may be of clinical interest to gauge the severity and residual gas concentrations during a hyperventilation event, especially if such an event is related to a chronic clinical condition. Breaths b4, b5, b6, and b7 would be the only ones recognized and analyzed for this condition. Analysis DD: It may be desired to consider alveolar concentration of gasses when the CO2 reaches a certain threshold, and compare those to other types of measurements for more sophisticated analysis, in which case a “wider” section of breaths b1, b2, and 8 would be ultimately analyzed. 
         [0122]      FIG. 28  is a pneumatic schematic describing an alternative configuration to the system described in  FIG. 24  in which a pump  12 ′ draws the sample from the patient Pt and propels the sample to various sample tubes A, B and C, and composition sensors SA, SB and SC, wherein the pump may be a peristaltic type pump so that the organization of the gas constituents in the gas path is not disrupted by the pump, in accordance with one variation. This figure shows one variation of an analysis system, which could include multiple analyte sensing means. Valves 2 and 3, and the pump are the same as in  FIG. 27  above. Valves V4, V6 and V8 are connected to separate sample chambers A, B and C respectively, each attached to a specific analyte&#39;s sensing means. Each of Sensors SA, SB and SC could be single gas or multiple analyte concentration sensing means. The exhaust at port a of valve V8 could be connected to additional sensing or storage means. The pump could be bi-directional, to allow for two-way movement of storage volume, and incremental analysis. For example, a two-tiered algorithm could be employed to first optimize accuracy, but if not enough gas volume was selected by a particular segments x, y, and z of Breaths 1, 2, and 8, respectively, then additional samples of storage volume gas prior to x, prior to y and prior to z could be added to the sample chamber A and presented to sensor SA. In this case, more volume would be available, but the degree of certainty that only the end-tidal portion was captured would be reduced. Finally, non-linear algorithms involving harmonic analysis, wavelets, and a series of other signal analysis tools could be applied adaptively to the waveform representing the stored breath parameters, to decide which sections of the breath should be analyzed. In systems that provide real time analysis, or analysis of single breath, estimates may be made about stability of the patient, regularity of the breath patterns, etc. With full storage of a number of breaths, the best breaths can be selected after the fact and analyzed, and if necessary, additional breaths, or additional sections of the breaths can be added to the original subsamples to increase accuracy, gas volume, or other parameters to be optimized. 
         [0123]    The system in  FIGS. 27 and 28  may contain a long capillary tube  18 ′ with one or more valves to store one or more breaths, which can then be retrieved, segment by segment for subsequent, offline chemical analysis, Some implementations may contain a long capillary tube (for single or multiple breath storage), optionally attached operatively to a pump (possibly with reversible flow), one or more valves that route the flow of the exhaled gas to one or more sensors. Additionally, as exhaled gas enters the tube  18 ′ or leaves it, its flow rate, and other fluidic parameters may be measured by flow-through sensors (for flow rate, CO2 concentration, temperature, etc.). Also, the exhaust of the gas at the pump, if used, can also be measured by flow-through sensors. 
         [0124]    Some variations of the present disclosure relate to storage, with time markers, of one or more breaths, which may similar to a computer shift register where a breath or breaths are loaded into the storage tube linearly, as exhaled, and detailed timing information is kept for each physical location of the breath, which may include flow rate, pressure, CO2 concentration, etc. Any section of the stored breath(s) can be loaded forward into a set of sensors, including same sections of multiple breaths. For example, if the end tidal concentration of a certain gas is a critical measurement (i.e. hydrogen), it may be necessary to obtain multiple readings of end tidal concentration from multiple breaths, collect them together and then analyze them using a fuel cell sensor. The reason it may be necessary to collect multiple samples is that the fuel cell sensors require a minimum volume of test gas, and also, the fuel cells require significant integration time to reach steady state—possibly several minutes. This may also be true for a number of other sensor types, including mass spectrometry, etc. Additionally, each breath may have a different morphology, especially if the patient has disorderly breathing due to the presence of a disease. In that case, it may be necessary to analyze each breath separately, and select only the end tidal portion (or no portion if the breath is not well defined), to assure that the correct part of the breath is being sampled. 
         [0125]    The process may entail collecting one or more breaths into the storage tube, with the timing information being kept separately, and then through engaging a combination of pumps and valves, routing only the relevant portions from one or more breaths to the one or more sensors. Particular attention must be paid to the inner diameter of the capillary tube, to assure that it is sufficiently large to allow for proper inflow of the exhaled gas without turbulent flows and mixing, while also being sufficiently small to prevent gas mixing. This also applies to the selection of the pump speed, which can be either fixed to allow for a range of breaths, or variable to account for breath-to-breath differences, as described in U.S. patent application Ser. No. 13/722,950, assigned to the assignee of the present application, the disclosure of which is incorporated by reference herein in its entirety. Information about pump speeds can be utilized later to “resample” the gasses in the storage tube. The process is very similar to digitally sampling analog signals with a sampling apparatus utilizing adjustable sampling rate. One re-sampling methodology involves using a “chirp” transform, to select the correct sampling points. 
         [0126]    Although this disclosure primarily describes variations where the breath storage compartment(s) and the analysis sensor(s) are in the same device, it should be understood that the storage compartment and analysis sensor may be separated. For example, the gas may be field-captured in a compartment configured to prevent mixing. The compartment may or may not be associated with a flow mechanism (such as a vacuum pump, for example) and a mechanism for determining and recording specific portions of the breath (such as a capnometer and software, for example). Then, the stored gas may be transported to a laboratory for the analysis to be performed. The analysis performed may include some or all of the analysis described herein, such as measuring a specific constituent of the breath and/or determining the beginning/end of a specific portion of the breath (such as an end-tidal portion, for example). 
         [0127]    Sensors may include fuel cells, MEMS fluidics sensors, optical benches, gas spectrometers, mass spectrometers, and any other type of sensor. Gases analyzed can include any standard gasses traditionally present in exhaled breath, anesthesia gases, unwanted inhaled gases (i.e. poisons, biochemical weapons), or gasses present due to metabolic processes (alcohol, drugs, disease, etc.). 
         [0128]    It is also contemplated that new technology on the horizon, such as nanotube sensor technology, may prove to be accurate enough to measure gas composition with the requisite accuracy and in real time. So, while many of the variations describe herein describe a separate breath pattern sensing sensor and step, and a separate gas composition sensor and step, the breath sensing and gas composition analysis steps can be performed by the same sensor, and potentially at the same time. In such apparatuses, the breath information registry variations described here may be beneficial. 
         [0129]    As used herein, the term end-tidal typically can be understood to refer to a section of the exhaled breath that is at or near the end of the expiratory period, and typically may be after the deadspace has been exhaled from the person. In addition to measuring gases such as CO in the end-tidal gas exemplified throughout the specification, it is also contemplated that non-gases such as particulates and other chemicals may be measured in the same manner. 
         [0130]    In the foregoing descriptions of variations of the invention, it should be noted that it is also conceived that the sequences of operation described in the Figures can be combined in all possible permutations. In addition, while the examples describe ETCO measurement they may apply to other gases, for example hydrogen. The examples provided throughout are illustrative of the principles of the invention, and that various modifications, alterations, and combinations can be made by those skilled in the art without departing from the scope and spirit of the invention. Any of the variations of the various breath measurement and sampling devices disclosed herein can include features described by any other breath measurement and sampling devices or combination of breath measurement and sampling devices herein. Accordingly, it is not intended that the invention be limited, except as by the appended claims. For all of the variations described above, the steps of the methods need not be performed sequentially.