In capillary alveolar blood, ethanol equilibrates rapidly with alveolar air in a ratio of approximately 2100:1 (blood : breath). Breath ethanol expressed as g/210L is approximately equivalent to g/dL whole blood ethanol. Traffic laws in the USA state that "alcohol concentration shall mean either grams of alcohol per 100 mL of blood or grams per 210 liters of breath" (8). Before breath analysis, a waiting period of 15 min is required to allow for clearance of any residual alcohol from very recent drinking, use of alcohol-containing mouthwash, or vomiting alcohol-rich gastric fluid.

The current Clinical Laboratory Improvement Act of 1988 does not regulate breath alcohol testing because a discrete sample is not collected or analyzed separately. A taskforce of the AACC Therapeutic Drug Monitoring and Clinical Toxicology Division has proposed several recommendations for a breath alcohol QA/QC program (Table 1) (9).

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