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Hirai K, Ishimaru M, Kato M, Sakamaki F, Yamaguchi K, Mochizuki H. A new method for objectively evaluating nocturnal cough in adults. Respir Investig 2022; 60:400-406. [PMID: 35067479 DOI: 10.1016/j.resinv.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/01/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND For the management of cough diseases in adults, an objective method of evaluating nocturnal cough is required. METHODS In Study 1, a cough monitoring system was evaluated using 25 adult volunteers. In Study 2, the cough monitoring system was validated using 20 samples from 10 adult patients with cough diseases obtained overnight. In hospitalized patients, our original cough monitoring system with a microphone and accelerometer was used. At the same time, coughs were recorded using a video camera with digital sound recording. The number of coughs in each 8-h video-audio recording was counted manually by three trained observers. All cough data were printed out, and the basal number of cough events, using both the printed-out data and video-audio recordings, were then calculated by three observers. RESULTS In Study 1, the cough monitoring system demonstrated good agreement with the number of coughs counted by examiners (sensitivity 99.2%, specificity 98.9%). In Study 2, there was significant agreement in the counts of natural coughs between our system and the video-audio method (p < 0.0001) and between our system and the basal cough events (p < 0.0001). CONCLUSIONS Our method demonstrated excellent agreement with the video-audio recording method in adults and is considered extremely useful for the objective monitoring of overnight cough in adult patients with cough diseases.
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Affiliation(s)
- Kota Hirai
- Department of Pediatrics, Tokai University School of Medicine, Japan; Department of Pediatrics, Tokai University Hachioji Hospital, Japan.
| | - Masanori Ishimaru
- Department of Pediatrics, Tokai University School of Medicine, Japan
| | - Masahiko Kato
- Department of Pediatrics, Tokai University School of Medicine, Japan; Department of Pediatrics, Tokai University Hachioji Hospital, Japan
| | - Fumio Sakamaki
- Department of Respiratory Medicine, Tokai University Hachioji Hospital, Japan
| | - Koichi Yamaguchi
- Department of Pediatrics, Tokai University School of Medicine, Japan; Department of Pediatrics, Tokai University Hachioji Hospital, Japan
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2
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Kelly CJ, Brown APY, Taylor JA. Artificial Intelligence in Pediatrics. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3
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Kowatsch T, Schachner T, Harperink S, Barata F, Dittler U, Xiao G, Stanger C, V Wangenheim F, Fleisch E, Oswald H, Möller A. Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study. J Med Internet Res 2021; 23:e25060. [PMID: 33484114 PMCID: PMC7929753 DOI: 10.2196/25060] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/19/2020] [Accepted: 01/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Successful management of chronic diseases requires a trustful collaboration between health care professionals, patients, and family members. Scalable conversational agents, designed to assist health care professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out to the everyday lives of patients and their family members. However, to date, it remains unclear whether conversational agents, in such a role, would be accepted and whether they can support this multistakeholder collaboration. OBJECTIVE With asthma in children representing a relevant target of chronic disease management, this study had the following objectives: (1) to describe the design of MAX, a conversational agent-delivered asthma intervention that supports health care professionals targeting child-parent teams in their everyday lives; and (2) to assess the (a) reach of MAX, (b) conversational agent-patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of health care professionals in primary and secondary care settings. METHODS MAX was designed to increase cognitive skills (ie, knowledge about asthma) and behavioral skills (ie, inhalation technique) in 10-15-year-olds with asthma, and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) to build a conversational agent-patient working alliance; (2) to offer hybrid (human- and conversational agent-supported) ubiquitous coaching; and (3) to provide an intervention with high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The conversational agent communicates with health care professionals via email, with patients via a mobile chat app, and with a family member via SMS text messaging. A single-arm feasibility study in primary and secondary care settings was performed to assess MAX. RESULTS Results indicated an overall positive evaluation of MAX with respect to its reach (49.5%, 49/99 of recruited and eligible patient-family member teams participated), a strong patient-conversational agent working alliance, and high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5%. Family members supported the patients in 269 out of 275 (97.8%) coaching sessions. Most of the conversational turns (99.5%) were conducted between patients and the conversational agent as opposed to between patients and health care professionals, thus indicating the scalability of MAX. In addition, it took health care professionals less than 4 minutes to assess the inhalation technique and 3 days to deliver related feedback to the patients. Several suggestions for improvement were made. CONCLUSIONS This study provides the first evidence that conversational agents, designed as mediating social actors involving health care professionals, patients, and family members, are not only accepted in such a "team player" role but also show potential to improve health-relevant outcomes in chronic disease management.
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Affiliation(s)
- Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
- Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Theresa Schachner
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Samira Harperink
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Filipe Barata
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Ullrich Dittler
- Fakultät Digitale Medien, Campus Furtwangen, Hochschule Furtwangen University, Furtwangen, Germany
| | - Grace Xiao
- Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Florian V Wangenheim
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Elgar Fleisch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
- Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Helmut Oswald
- Department of Child and Adolescent Health, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Alexander Möller
- Division of Respiratory Medicine and Childhood Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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4
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Artificial Intelligence in Pediatrics. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_316-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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5
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Rassouli F, Tinschert P, Barata F, Steurer-Stey C, Fleisch E, Puhan MA, Baty F, Kowatsch T, Brutsche MH. Characteristics of Asthma-related Nocturnal Cough: A Potential New Digital Biomarker. J Asthma Allergy 2020; 13:649-657. [PMID: 33299332 PMCID: PMC7721277 DOI: 10.2147/jaa.s278119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/31/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The nature of nocturnal cough is largely unknown. It might be a valid marker for asthma control but very few studies characterized it as a basis for better defining its role and its use as clinical marker. This study investigated prevalence and characteristics of nocturnal cough in asthmatics over the course of four weeks. Methods In two centers, 94 adult patients with physician-diagnosed asthma were recruited. Patient-reported outcomes and nocturnal sensor data were collected by a smartphone with a chat-based study app. Results Patients coughed in 53% of 2212 nights (range: 0–345 coughs/night). Median coughs per hour were 0 (IQR 0–1). Nocturnal cough rates showed considerable inter-individual variance. The highest counts were measured in the first 30 min in bed (4.5-fold higher than rest of night). Eighty-six percent of coughs were part of a cough cluster. Clusters consisted of a median of two coughs (IQR 2–4). Nocturnal cough was persistent within patient. Conclusion To the best of the authors’ knowledge, this study is the first to describe prevalence and characteristics of nocturnal cough in asthma over a period of one month, demonstrating that it was a prevalent symptom with large variance between patients and high persistence within patients. Cough events in asthmatics were 4.5 times more frequent within the first 30 min in bed indicating a potential role of positional change, and not more frequent during the early morning hours. An important next step will investigate the association between nocturnal cough and asthma control.
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Affiliation(s)
- Frank Rassouli
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Peter Tinschert
- Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Filipe Barata
- Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Claudia Steurer-Stey
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,mediX Group Practice Zurich, Zurich, Switzerland
| | - Elgar Fleisch
- Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland.,Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Milo Alan Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Florent Baty
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Tobias Kowatsch
- Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland.,Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
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Chang AB, Oppenheimer JJ, Irwin RS, Adams TM, Altman KW, Azoulay E, Blackhall F, Birring SS, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Chang AB, Cowley T, Davenport P, El Solh AA, Escalante P, Field SK, Fisher D, French CT, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Kavanagh J, Keogh KA, Lai K, Lane AP, Lilly C, Lim K, Lown M, Madison JM, Malesker MA, Mazzone S, McGarvey L, Molasoitis A, Murad MH, Narasimhan M, Oppenheimer J, Russell RJ, Ryu JH, Singh S, Smith MP, Tarlo SM, Vertigan AE. Managing Chronic Cough as a Symptom in Children and Management Algorithms. Chest 2020; 158:303-329. [DOI: 10.1016/j.chest.2020.01.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
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Hirai K, Nukaga M, Tabata H, Enseki M, Furuya H, Niimura F, Yamaguchi K, Mochizuki H. Objective measurement of nocturnal cough in infants with acute bronchiolitis. Respir Investig 2019; 57:605-610. [PMID: 31327680 DOI: 10.1016/j.resinv.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/10/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The objective measurement of the cough severity and the assessment of the pattern of nocturnal coughing could be useful in the treatment of respiratory diseases in children. STUDY DESIGN In children with respiratory syncytial virus (RSV)-induced acute bronchiolitis, coughs were recorded using our original system with a microphone and accelerometer, and analyzed using our customized software program. The number of coughs in every 30-minute interval was measured in patients with acute bronchiolitis (n = 20), and their results were compared with those of infants with asthma exacerbation (n = 16). RESULTS The cough count in children with acute bronchiolitis (median: 108.0/night) was almost as high as that in children with asthma exacerbation (median: 119/night). However, the time-dependent pattern of overnight cough was different in infants with acute bronchiolitis and those with asthma exacerbation. In the infants with asthma exacerbation, cough frequency significantly increased while falling asleep and waking up as compared to midnight (p < 0.001 and p < 0.001, respectively). However, these differences were not found in infants with acute bronchiolitis. CONCLUSIONS Our data demonstrated that the number of coughing events due to acute bronchiolitis was similar to that of acute asthma exacerbation, although the acute bronchiolitis did not show a characteristic overnight cough pattern.
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Affiliation(s)
- Kota Hirai
- Department of Pediatrics, Tokai University Hachioji Hospital, 1838, Ishikawa, Hachioji, Tokyo, 192-0032 Japan.
| | - Mariko Nukaga
- Department of Pediatrics, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
| | - Hideyuki Tabata
- Department of Pediatrics, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
| | - Mayumi Enseki
- Department of Pediatrics, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
| | - Hiroyuki Furuya
- Department of Basic Clinical Science and Public Health, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
| | - Fumio Niimura
- Department of Pediatrics, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
| | - Koichi Yamaguchi
- Department of Pediatrics, Tokai University Hachioji Hospital, 1838, Ishikawa, Hachioji, Tokyo, 192-0032 Japan.
| | - Hiroyuki Mochizuki
- Department of Pediatrics, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
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Huffaker MF, Carchia M, Harris BU, Kethman WC, Murphy TE, Sakarovitch CCD, Qin F, Cornfield DN. Passive Nocturnal Physiologic Monitoring Enables Early Detection of Exacerbations in Children with Asthma. A Proof-of-Concept Study. Am J Respir Crit Care Med 2018; 198:320-328. [PMID: 29688023 PMCID: PMC6835062 DOI: 10.1164/rccm.201712-2606oc] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/23/2018] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Asthma management depends on prompt identification of symptoms, which challenges both patients and providers. In asthma, a misapprehension of health between exacerbations can compromise compliance. Thus, there is a need for a tool that permits objective longitudinal monitoring without increasing the burden of patient compliance. OBJECTIVES We sought to determine whether changes in nocturnal physiology are associated with asthma symptoms in pediatric patients. METHODS Using a contactless bed sensor, nocturnal heart rate (HR), respiratory rate, relative stroke volume, and movement in children with asthma 5-18 years of age (n = 16) were recorded. Asthma symptoms and asthma control test (ACT) score were reported every 2 weeks. Random forest model was used to identify physiologic parameters associated with asthma symptoms. Elastic net regression was used to identify variables associated with ACT score. MEASUREMENTS AND MAIN RESULTS The model on the full cohort performed with sensitivity of 47.2%, specificity of 96.3%, and accuracy of 87.4%; HR and respiratory parameters were the most important variables in this model. The model predicted asthma symptoms 35% of the time on the day before perception of symptoms, and 100% of the time for a select subject for which the model performed with greater sensitivity. Multivariable and bivariable analyses demonstrated significant association between HR and respiratory rate parameters and ACT score. CONCLUSIONS Nocturnal physiologic changes correlate with asthma symptoms, supporting the notion that nocturnal physiologic monitoring represents an objective diagnostic tool capable of longitudinally assessing disease control and predicting asthma exacerbations in children with asthma at home.
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Affiliation(s)
| | | | - Bronwyn U. Harris
- Department of Pediatrics–Cardiology
- Tueo Health, Inc., San Francisco, California
| | | | | | | | | | - David N. Cornfield
- Center for Excellence in Pulmonary Biology, Division of Pulmonary, Asthma, and Sleep Medicine, Department of Pediatrics, Stanford University Medical School, Stanford, California; and
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Lai T, Wu M, Liu J, Luo M, He L, Wang X, Wu B, Ying S, Chen Z, Li W, Shen H. Acid-Suppressive Drug Use During Pregnancy and the Risk of Childhood Asthma: A Meta-analysis. Pediatrics 2018; 141:peds.2017-0889. [PMID: 29326337 DOI: 10.1542/peds.2017-0889] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The association between acid-suppressive drug exposure during pregnancy and childhood asthma has not been well established. OBJECTIVE To conduct a systematic review and meta-analysis on this association to provide further justification for the current studies. DATA SOURCES We searched PubMed, Medline, Embase, the Cochrane Database of Systematic Reviews, EBSCO Information Services, Web of Science, and Google Scholar from inception until June 2017. STUDY SELECTION Observational studies in which researchers assessed acid-suppressive drug use during pregnancy and the risk of childhood asthma were included. DATA EXTRACTION Of 556 screened articles, 8 population-based studies were included in the final analyses. RESULTS When all the studies were pooled, acid-suppressive drug use in pregnancy was associated with an increased risk of asthma in childhood (relative risk [RR] = 1.45; 95% confidence interval [CI] 1.35-1.56; I2 = 0%; P < .00001). The overall risk of asthma in childhood increased among proton pump inhibitor users (RR = 1.34; 95% CI 1.18-1.52; I2 = 46%; P < .00001) and histamine-2 receptor antagonist users (RR = 1.57; 95% CI 1.46-1.69; I2 = 0%; P < .00001). LIMITATIONS None of the researchers in the studies in this meta-analysis adjusted for the full panel of known confounders in these associations. CONCLUSIONS The evidence suggests that prenatal, maternal, acid-suppressive drug use is associated with an increased risk of childhood asthma. This information may help clinicians and parents to use caution when deciding whether to take acid-suppressing drugs during pregnancy because of the risk of asthma in offspring.
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Affiliation(s)
- Tianwen Lai
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Institute of Respiratory Diseases, School of Medicine, Zhejiang University, Zhejiang Sheng, China.,Department of Respiratory and Critical Care Medicine, Institute of Respiratory Diseases, The Affiliated Hospital of Guangdong Medical University, Guangdong Sheng, China
| | - Mindan Wu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Institute of Respiratory Diseases, School of Medicine, Zhejiang University, Zhejiang Sheng, China
| | - Juan Liu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Institute of Respiratory Diseases, School of Medicine, Zhejiang University, Zhejiang Sheng, China.,Institute of Lung Biology and Disease, Helmholtz Zentrum München, German Center for Lung Research, Oberschleißheim, Germany; and
| | - Man Luo
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Institute of Respiratory Diseases, School of Medicine, Zhejiang University, Zhejiang Sheng, China
| | - Lulu He
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Institute of Respiratory Diseases, School of Medicine, Zhejiang University, Zhejiang Sheng, China
| | - Xiaohui Wang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Institute of Respiratory Diseases, School of Medicine, Zhejiang University, Zhejiang Sheng, China
| | - Bin Wu
- Department of Respiratory and Critical Care Medicine, Institute of Respiratory Diseases, The Affiliated Hospital of Guangdong Medical University, Guangdong Sheng, China
| | - Songmin Ying
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Institute of Respiratory Diseases, School of Medicine, Zhejiang University, Zhejiang Sheng, China
| | - Zhihua Chen
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Institute of Respiratory Diseases, School of Medicine, Zhejiang University, Zhejiang Sheng, China
| | - Wen Li
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Institute of Respiratory Diseases, School of Medicine, Zhejiang University, Zhejiang Sheng, China
| | - Huahao Shen
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Institute of Respiratory Diseases, School of Medicine, Zhejiang University, Zhejiang Sheng, China; .,State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
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10
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Imai E, Hirai K, Mikami Y, Nukaga M, Enseki M, Tabata H, Kato M, Mochizuki H. An objective evaluation of nocturnal cough count and cough pattern in children with psychogenic cough. Respir Investig 2017; 55:334-337. [PMID: 29153413 DOI: 10.1016/j.resinv.2017.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 11/29/2022]
Abstract
Two patients with a chronic, barking cough were diagnosed with psychogenic cough. Using an original cough counter we studied the nocturnal cough count and pattern. While the number of coughs when awake was extremely high for both patients, the number of coughs was remarkably reduced during sleep, similar to an exacerbation of asthma. Moreover, the properties of the coughs when awake were clearly different from those of coughs during sleep. In conclusion, an objective examination using a cough counter was useful for the diagnosis, treatment and management of psychogenic cough.
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Affiliation(s)
- Eri Imai
- Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Kota Hirai
- Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | - Yoshiko Mikami
- Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Mariko Nukaga
- Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Mayumi Enseki
- Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Hideyuki Tabata
- Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Masahiko Kato
- Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Hiroyuki Mochizuki
- Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
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