Broadly tunable external cavity quantum cascade lasers (EC-QCLs) in combination with off-axis integrated cavity enhanced spectroscopy (OA-ICOS) provide high molecular gas sensitivity and selectivity. We used an EC-QCL in the region of 1150–1300 cm−1 in both broadband scan mode, as well as narrow scanning mode around 1216 cm−1, respectively, for detection of acetone in exhaled breath. This wavelength region is essential for accurate determination of breath acetone due to the relative low spectral influence of other endogenous molecules like water, carbon dioxide or methane. We demonstrated that ethanol has a strong spectroscopic influence on the acetone concentration in exhaled breath, an important detail that has been overlooked so far. An ethanol correction is proposed and validated with the reference measurements from a proton-transfer reaction mass spectrometer (PTR-MS) for the same breath samples from ten persons. With the ethanol correction, both broadband and narrowband molecular spectroscopy represent an attractive way to accurately assess the exhaled breath acetone. The importance of considering spectroscopic ethanol influence is essential, especially for the narrowband scans, (e.g., 1216 cm−1), for which the error in determining the acetone concentrations can rise up to 39% if it is not considered.