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Barata F, Cleres D, Tinschert P, Iris Shih CH, Rassouli F, Boesch M, Brutsche M, Fleisch E. Nighttime Continuous Contactless Smartphone-Based Cough Monitoring for the Ward: Validation Study. JMIR Form Res 2023; 7:e38439. [PMID: 36655551 PMCID: PMC9989914 DOI: 10.2196/38439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/17/2022] [Accepted: 01/17/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Clinical deterioration can go unnoticed in hospital wards for hours. Mobile technologies such as wearables and smartphones enable automated, continuous, noninvasive ward monitoring and allow the detection of subtle changes in vital signs. Cough can be effectively monitored through mobile technologies in the ward, as it is not only a symptom of prevalent respiratory diseases such as asthma, lung cancer, and COVID-19 but also a predictor of acute health deterioration. In past decades, many efforts have been made to develop an automatic cough counting tool. To date, however, there is neither a standardized, sufficiently validated method nor a scalable cough monitor that can be deployed on a consumer-centric device that reports cough counts continuously. These shortcomings limit the tracking of coughing and, consequently, hinder the monitoring of disease progression in prevalent respiratory diseases such as asthma, chronic obstructive pulmonary disease, and COVID-19 in the ward. OBJECTIVE This exploratory study involved the validation of an automated smartphone-based monitoring system for continuous cough counting in 2 different modes in the ward. Unlike previous studies that focused on evaluating cough detection models on unseen data, the focus of this work is to validate a holistic smartphone-based cough detection system operating in near real time. METHODS Automated cough counts were measured consistently on devices and on computers and compared with cough and noncough sounds counted manually over 8-hour long nocturnal recordings in 9 patients with pneumonia in the ward. The proposed cough detection system consists primarily of an Android app running on a smartphone that detects coughs and records sounds and secondarily of a backend that continuously receives the cough detection information and displays the hourly cough counts. Cough detection is based on an ensemble convolutional neural network developed and trained on asthmatic cough data. RESULTS In this validation study, a total of 72 hours of recordings from 9 participants with pneumonia, 4 of whom were infected with SARS-CoV-2, were analyzed. All the recordings were subjected to manual analysis by 2 blinded raters. The proposed system yielded a sensitivity and specificity of 72% and 99% on the device and 82% and 99% on the computer, respectively, for detecting coughs. The mean differences between the automated and human rater cough counts were -1.0 (95% CI -12.3 to 10.2) and -0.9 (95% CI -6.5 to 4.8) coughs per hour within subject for the on-device and on-computer modes, respectively. CONCLUSIONS The proposed system thus represents a smartphone cough counter that can be used for continuous hourly assessment of cough frequency in the ward.
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Affiliation(s)
- Filipe Barata
- Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - David Cleres
- Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Peter Tinschert
- Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.,Resmonics AG, Zurich, Switzerland
| | - Chen-Hsuan Iris Shih
- Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.,Resmonics AG, Zurich, Switzerland
| | - Frank Rassouli
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Martin Brutsche
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Elgar Fleisch
- Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.,Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
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Moaeri S, Hildebrandt O, Cassel W, Viniol C, Schäfer A, Kesper K, Sohrabi K, Gross V, Koehler U. [Analysis of Snoring in Patients with Obstructive Sleep Apnea (OSA) by Polysomnography and LEOSound]. Laryngorhinootologie 2023; 102:118-123. [PMID: 36580974 DOI: 10.1055/a-1949-3135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Snoring was monitored in patients with obstructive sleep apnea (OSA) using the LEOSound-Monitor and simultaneously polysomnographic (PSG) recording. In obstructive apneas snoring is normally apparent after apnea termination and the beginning of ventilation. We wanted to know how often obstructive apneas are terminated by ventilation in combination with snoring. METHODS AND INTENTION In 40 patients with OSA (AHI > 15/h) simultaneous polysomnographic recordings were performed amongst long-term respiratory sound monitoring using the LEOSound monitor. Patients' average age was 57±11 years. Average weight was 100±19 kg by a mean body mass index (BMI) of 33±7 kg/m2. 12 out of 40 recordings had to be rejected for further analysis because of artifacts. Snoring recorded by polysomnography was compared with snoring monitored by LEOSound. RESULTS 3778 obstructive apnea episodes were monitored. LEOSound identified snoring in 1921 (51,0%), polysomnography in 2229 (58,8%) obstructive apneas. Only in one patient there was a higher difference in snoring episodes between PSG and LEOSound. DISCUSSION In nearly 60% of obstructive apnea events we found snoring during apnea-terminating hyperpnoea. LEOSound is a good diagnostic tool to monitor snoring. It is necessary to clarify why only 60% of all obstructive events/hyperpnoea develop snoring. From a pathophysiological point of view opening of collapsed upper airway should lead in a very high percentage to turbulences in airstream and committed snoring.
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Affiliation(s)
- S Moaeri
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
| | - Olaf Hildebrandt
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
| | - W Cassel
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
| | - C Viniol
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
| | - A Schäfer
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
| | - K Kesper
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
| | - K Sohrabi
- Fachbereich Gesundheit, Technische Hochschule Mittelhessen, Gießen
| | - V Gross
- Fachbereich Gesundheit, Technische Hochschule Mittelhessen, Gießen
| | - Ulrich Koehler
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg
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Boeselt T, Kroenig J, Lueders TS, Koehler N, Beutel B, Hildebrandt O, Koehler U, Conradt R. Acoustic Monitoring of Night-Time Respiratory Symptoms in 14 Patients with Exacerbated COPD Over a 3- Week Period. Int J Chron Obstruct Pulmon Dis 2022; 17:2977-2986. [DOI: 10.2147/copd.s377069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/05/2022] [Indexed: 11/19/2022] Open
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Tabatabaei SAH, Fischer P, Schneider H, Koehler U, Gross V, Sohrabi K. Methods for Adventitious Respiratory Sound Analyzing Applications Based on Smartphones: A Survey. IEEE Rev Biomed Eng 2021; 14:98-115. [PMID: 32746364 DOI: 10.1109/rbme.2020.3002970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Detection and classification of adventitious acoustic lung sounds plays an important role in diagnosing, monitoring, controlling and, caring the patients with lung diseases. Such systems can be presented as different platforms like medical devices, standalone software or smartphone application. Ubiquity of smartphones and widespread use of the corresponding applications make such a device an attractive platform for hosting the detection and classification systems for adventitious lung sounds. In this paper, the smartphone-based systems for automatic detection and classification of the adventitious lung sounds are surveyed. Such adventitious sounds include cough, wheeze, crackle and, snore. Relevant sounds related to abnormal respiratory activities are considered as well. The methods are shortly described and the analyzing algorithms are explained. The analysis includes detection and/or classification of the sound events. A summary of the main surveyed methods together with the classification parameters and used features for the sake of comparison is given. Existing challenges, open issues and future trends will be discussed as well.
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5
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Lindenhofer M, Roth L, Mädel C, Götzinger F, Kainz K, Lex C, Frischer T, Reinweber M, Zacharasiewicz A. Wheeze and cough measurements at night in children with respiratory symptoms. BMC Pediatr 2020; 20:556. [PMID: 33308199 PMCID: PMC7733140 DOI: 10.1186/s12887-020-02455-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023] Open
Abstract
Background Nocturnal cough and wheeze are important symptoms when diagnosing any respiratory disease in a child, but objective measurements of these symptoms are not performed. Methods The aim of our study was to analyze the use of an automated detection system to assess breath sounds objectively in comparison to cough and wheeze questionnaires and to evaluate its feasibility in clinical practice. Results Forty-nine recordings of thirty-nine children were processed (asthma n = 13; cystic fibrosis n = 2; pneumonia n = 5; suspicion of habit cough n = 7; prolonged, recurrent or chronic cough n = 13), and cough and asthma scores were compared to the objective nocturnal recordings. Time for audio-validation of recordings took between 2 and 40 min (mean: 14.22 min, (SD): 10.72). Accuracy of the automated measurement was higher for cough than for wheezing sounds. Nocturnal cough readings but not wheeze readings correlated with some of the corresponding scores. Conclusion To our knowledge this is the first study using a new device to assess nocturnal cough and obstructive breath sounds objectively in children with a wide variety of respiratory diseases. The assessment proved user friendly. We obtained additional information on nighttime symptoms, which would otherwise have remained obscure. Further studies to assess possible diagnostic and therapeutic benefits of this device are needed.
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Affiliation(s)
- Markus Lindenhofer
- Klinikum Favoriten, Wiener Gesundheitsverbund, Wien, Austria.,Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Lena Roth
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Clemens Mädel
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Florian Götzinger
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Katharina Kainz
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria
| | - Christiane Lex
- Department for Pediatric Cardiology and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Thomas Frischer
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | | | - Angela Zacharasiewicz
- Wilhelminenspital, Klinikum Ottakring, Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Montleartstrasse 37, 1160, Wien, Austria.
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Doenges J, Kuckuck E, Cassel W, Hildebrandt O, Weissflog A, Sohrabi K, Koehler N, Gross V, Greulich T, Koehler U. Disease control in patients with asthma and respiratory symptoms (wheezing, cough) during sleep. Asthma Res Pract 2020; 6:9. [PMID: 32983550 PMCID: PMC7513478 DOI: 10.1186/s40733-020-00062-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/09/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The Global Initiative for Asthma (GINA)-defined criteria for asthma control include questions about daytime symptoms, limitation of activity, nocturnal symptoms, need for reliever treatment and patients' satisfaction. Patients with nocturnal symptoms like wheezing and cough often suffer from lower sleep quality and impaired daytime performance. The lack of an appropriate method for standardized and objective monitoring of respiratory symptoms leads to difficulties in asthma management. The aim of this study is to present a new method for automated wheeze and cough detection during sleep and to assess the actual level of asthma control by the Asthma Control Test (ACT). METHODS Respiratory symptoms like wheezing and cough were recorded with the LEOSound-Monitor for one night in 55 asthmatic patients in their individual domestic setting. Patients were asked to assess their level of asthma subjectively with the ACT. The study consisted of 37 women and 18 men, with a mean age of 41 years, and a mean BMI of 27 kg/m2. Most of the patients had been taking an ICS/LABA combination and would resort to a SABA as their rescue medication. RESULTS 60% of the participants were classed as having controlled, and 40% were classed as having partially- or uncontrolled asthma. During sleep wheezing was found in 8 of the 55 asthma patients (14.5%) and coughing was found in 30 patients (54.5%). The median ACT score in wheezing-patients was 14, while in non-wheezing patients it was 21. Uncontrolled asthma was found in 6 of the 8 wheezing-patients. Coughing versus non-coughing patients did not show a significant difference in the ACT-score (20, 22 respectively). CONCLUSION Wheezing is a sign of uncontrolled asthma. The ACT-score in wheezing patients is worse compared to patients without wheezing. LEOSound proofed to be a useful tool in providing an objective evaluation of respiratory symptoms, like coughing and wheezing. In clinical practice, this may allow an improvement in asthma therapy.
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Affiliation(s)
- Jonathan Doenges
- Department of Internal Medicine, Division of Pneumology, Intensive Care and Sleep Medicine, Hospital of the University of Marburg, Baldingerstrasse 1, 35033 Marburg, Germany
| | - Elisabeth Kuckuck
- Department of Internal Medicine, Division of Pneumology, Intensive Care and Sleep Medicine, Hospital of the University of Marburg, Baldingerstrasse 1, 35033 Marburg, Germany
| | - Werner Cassel
- Department of Internal Medicine, Division of Pneumology, Intensive Care and Sleep Medicine, Hospital of the University of Marburg, Baldingerstrasse 1, 35033 Marburg, Germany
| | - Olaf Hildebrandt
- Department of Internal Medicine, Division of Pneumology, Intensive Care and Sleep Medicine, Hospital of the University of Marburg, Baldingerstrasse 1, 35033 Marburg, Germany
| | | | - Keywan Sohrabi
- University of Applied Sciences, Faculty of Health Sciences, Gießen, Germany
| | - Niklas Koehler
- University of Applied Sciences, Faculty of Health Sciences, Gießen, Germany
| | - Volker Gross
- University of Applied Sciences, Faculty of Health Sciences, Gießen, Germany
| | - Timm Greulich
- Department of Internal Medicine, Division of Pneumology, Intensive Care and Sleep Medicine, Hospital of the University of Marburg, Baldingerstrasse 1, 35033 Marburg, Germany
| | - Ulrich Koehler
- Department of Internal Medicine, Division of Pneumology, Intensive Care and Sleep Medicine, Hospital of the University of Marburg, Baldingerstrasse 1, 35033 Marburg, Germany
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Moaeri S, Hildebrandt O, Cassel W, Viniol C, Schäfer A, Kesper K, Sohrabi K, Gross V, Koehler U. [Analysis of Snoring in Patients with Obstructive Sleep Apnea (OSA) by Polysomnography and LEOSound]. Pneumologie 2020; 74:509-514. [PMID: 32492719 DOI: 10.1055/a-1155-8772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Snoring was monitored in patients with obstructive sleep apnea (OSA) using the LEOSound-Monitor and simultaneously polysomnographic (PSG) recording. In obstructive apneas snoring is normally apparent after apnea termination and the beginning of ventilation. We wanted to know how often obstructive apneas are terminated by ventilation in combination with snoring. METHODS AND INTENTION In 40 patients with OSA (AHI > 15/h) simultaneous polysomnographic recordings were performed amongst long-term respiratory sound monitoring using the LEOSound monitor. Patients' average age was 57 ± 11 years. Average weight was 100 ± 19 kg by a mean body mass index (BMI) of 33 ± 7 kg/m2. 12 out of 40 recordings had to be rejected for further analysis because of artifacts. Snoring recorded by polysomnography was compared with snoring monitored by LEOSound. RESULTS 3778 obstructive apnea episodes were monitored. LEOSound identified snoring in 1921 (51,0 %), polysomnography in 2229 (58,8 %) obstructive apneas. Only in one patient there was a higher difference in snoring episodes between PSG and LEOSound. DISCUSSION In nearly 60 % of obstructive apnea events we found snoring during apnea-terminating hyperpnoea. LEOSound is a good diagnostic tool to monitor snoring. It is necessary to clarify why only 60 % of all obstructive events/hyperpnoea develop snoring. From a pathophysiological point of view opening of collapsed upper airway should lead in a very high percentage to turbulences in airstream and committed snoring.
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Affiliation(s)
- S Moaeri
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - O Hildebrandt
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - W Cassel
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - C Viniol
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - A Schäfer
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - K Kesper
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - K Sohrabi
- Fachbereich Gesundheit, Technische Hochschule Mittelhessen, Gießen
| | - V Gross
- Fachbereich Gesundheit, Technische Hochschule Mittelhessen, Gießen
| | - U Koehler
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
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Braghiroli A, Braido F, Piraino A, Rogliani P, Santus P, Scichilone N. Day and Night Control of COPD and Role of Pharmacotherapy: A Review. Int J Chron Obstruct Pulmon Dis 2020; 15:1269-1285. [PMID: 32606638 PMCID: PMC7283230 DOI: 10.2147/copd.s240033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/03/2020] [Indexed: 12/30/2022] Open
Abstract
The topic of 24-hour management of COPD is related to day-to-night symptoms management, specific follow-up and patients' adherence to therapy. COPD symptoms strongly vary during day and night, being worse in the night and early morning. This variability is not always adequately considered in the trials. Night-time symptoms are predictive of higher mortality and more frequent exacerbations; therefore, they should be a target of therapy. During night-time, in COPD patients the supine position is responsible for a different thoracic physiology; moreover, during some sleep phases the vagal stimulation determines increased bronchial secretions, increased blood flow in the bronchial circulation (enhancing inflammation) and increased airway resistance (broncho-motor tone). Moreover, in COPD patients the circadian rhythm may be impaired. The role of pharmacotherapy in this regard is still poorly investigated. Symptoms can be grossly differentiated according to the different phenotypes of the disease: wheezing recalls asthma, while dyspnea is strongly related to emphysema (dynamic hyperinflation) or obstructive bronchiolitis (secretions). Those symptoms may be different targets of therapy. In this regard, GOLD recommendations for the first time introduced the concept of phenotype distinction suggesting the use of inhaled corticosteroids (ICS) particularly when an asthmatic pattern or eosiophilic inflammations are present, and hypothesized different approaches to target symptoms (ie, dyspnea) or exacerbations. Pharmacotherapy should be evaluated and possibly directed on the basis of circadian variations, for instance, supporting the use of twice-daily rapid-action bronchodilators and evening dose of ICS. Recommendations on day and night symptoms monitoring strategies and choice of the specific drug according to patient's profile are still not systematically investigated or established. This review is the summary of an advisory board on the topic "24-hour control of COPD and role of pharmacotherapy", held by five pulmonologists, experts in respiratory pathophysiology, pharmacology and sleep medicine.
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Affiliation(s)
- Alberto Braghiroli
- Department of Pulmonary Rehabilitation, Sleep Laboratory, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, NO, Italy
| | - Fulvio Braido
- Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genoa, Azienda Policlinico IRCCS San Martino, Genoa, Italy
| | - Alessio Piraino
- Respiratory Area, Medical Affairs Chiesi Italia, Parma, Italy
| | - Paola Rogliani
- Respiratory Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Pierachille Santus
- Pierachille Santus, Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Milan, Italy
| | - Nicola Scichilone
- Department of Biomedicine and Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy
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Koehler U, Hildebrandt O, Fischer P, Gross V, Sohrabi K, Timmesfeld N, Peter S, Urban C, Steiß JO, Koelsch S, Kerzel S, Weissflog A. Time course of nocturnal cough and wheezing in children with acute bronchitis monitored by lung sound analysis. Eur J Pediatr 2019; 178:1385-1394. [PMID: 31321530 PMCID: PMC6694092 DOI: 10.1007/s00431-019-03426-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 11/02/2022]
Abstract
Cough and wheezing are the predominant symptoms of acute bronchitis. Hitherto, the evaluation of respiratory symptoms was limited to subjective methods such as questionnaires. The main objective of this study was to objectively determine the time course of cough and wheezing in children with acute bronchitis. The impact of nocturnal cough on parent's quality of life was assessed as secondary outcome. In 36 children (2-8 years), the frequency of nocturnal cough and wheezing was recorded during three nights by automated lung sound monitoring. Additionally, parents completed symptom logs, i.e., the Bronchitis Severity Score (BSS), as well as the Parent-proxy Children's Acute Cough-specific Quality of Life Questionnaire (PAC-QoL). During the first night, patients had 34.4 ± 52.3 (mean ± SD) cough epochs, which were significantly reduced in night 5 (13.5 ± 26.5; p < 0.001) and night 9 (12.8 ± 28.1; p < 0.001). Twenty-two patients had concomitant wheezing, which declined within the observation period as well. All subjective parameters (BSS, Cough log and PAC-QoL) were found to be significantly correlated with the objectively assessed cough parameters.Conclusion: Long-term recording of cough and wheezing offers a useful opportunity to objectively evaluate the time course of respiratory symptoms in children with acute bronchitis. To assess putative effects of pharmacotherapy on nocturnal bronchitis symptoms, future studies in more homogeneous patient groups are needed. What is Known: • Cough and wheezing are the predominant symptoms of acute bronchitis. • There is a diagnostic gap in long-term assessment of these respiratory symptoms, which needs to be closed to optimize individual therapies. What is New: • Long-term recording of nocturnal cough and wheezing allows for objective evaluation of respiratory symptoms in children with acute bronchitis and provides a tool to validate the efficacy of symptomatic bronchitis therapies.
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Affiliation(s)
- Ulrich Koehler
- Department of Internal Medicine, Pneumology, Intensive Care and Sleep Medicine, University Hospital of Marburg and Gießen, Philipps-Universität, Baldingerstrasse 1, 35043 Marburg, Germany
| | - Olaf Hildebrandt
- Department of Internal Medicine, Pneumology, Intensive Care and Sleep Medicine, University Hospital of Marburg and Gießen, Philipps-Universität, Baldingerstrasse 1, 35043 Marburg, Germany
| | - Patrick Fischer
- Faculty of Health Sciences, University of Applied Sciences, Gießen, Germany
| | - Volker Gross
- Faculty of Health Sciences, University of Applied Sciences, Gießen, Germany
| | - Keywan Sohrabi
- Faculty of Health Sciences, University of Applied Sciences, Gießen, Germany
| | - Nina Timmesfeld
- Department of Medicine, Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany
| | - Saskia Peter
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg, St. Hedwig Campus, Regensburg, Germany
| | | | - Jens-Oliver Steiß
- Division of Pediatric Pulmonology and Allergy, Department of Pediatrics and Neonatology, University Hospital of Marburg and Gießen, Gießen, Germany
| | - Stephan Koelsch
- CHC Medical Affairs, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg, St. Hedwig Campus, Regensburg, Germany
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Fischer P, Gross V, Kroenig J, Weissflog A, Hildebrandt O, Sohrabi K, Koehler U. Description of nighttime cough epochs in patients with stable COPD GOLD II-IV. Int J Chron Obstruct Pulmon Dis 2018; 13:1071-1078. [PMID: 29662309 PMCID: PMC5892620 DOI: 10.2147/copd.s154539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Chronic cough is one of the main symptoms of COPD. Ambulatory objective monitoring provides novel insights into the determinants and characteristics of nighttime cough in COPD. Materials and methods Nighttime cough was monitored objectively by LEOSound lung sound monitor in patients with stable COPD II–IV. In 30 patients, with 10 patients in each stage group, nighttime cough was analyzed for epoch frequency, epoch severity (epoch length and coughs per epoch), and pattern (productive or nonproductive). Results Cough was found in all patients ranging from 1 to 294 events over the recording period. In 29 patients, cough epochs were monitored, ranging from 1 to 75 epochs. The highest amount of cough epochs was found in patients with COPD stage III. Active smokers had significantly more productive cough epochs (61%) than nonsmokers (24%). Conclusion We found a high rate of nighttime cough epochs in patients with COPD, especially in those in stage III. Productive cough was predominantly found in patients with persistent smoking. LEOSound lung sound monitor offers a practical and valuable opportunity to evaluate cough objectively.
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Affiliation(s)
- Patrick Fischer
- Faculty of Health Sciences, University of Applied Sciences, Giessen, Germany
| | - Volker Gross
- Faculty of Health Sciences, University of Applied Sciences, Giessen, Germany
| | - Johannes Kroenig
- Department of Pneumology, Intensive Care and Sleep Medicine, University Hospital of Marburg and Giessen, Marburg, Germany
| | | | - Olaf Hildebrandt
- Department of Pneumology, Intensive Care and Sleep Medicine, University Hospital of Marburg and Giessen, Marburg, Germany
| | - Keywan Sohrabi
- Faculty of Health Sciences, University of Applied Sciences, Giessen, Germany.,Institute for Medical Informatics, Justus-Liebig-University Giessen, Giessen, Germany
| | - Ulrich Koehler
- Department of Pneumology, Intensive Care and Sleep Medicine, University Hospital of Marburg and Giessen, Marburg, Germany
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Krönig J, Hildebrandt O, Weissflog A, Cassel W, Gross V, Sohrabi K, Fischer P, Koehler U. Long-term Recording of Night-Time Respiratory Symptoms in Patients with Stable COPD II-IV. COPD 2017; 14:498-503. [PMID: 28715232 DOI: 10.1080/15412555.2017.1338681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Night-time respiratory symptoms have a considerable impact on sleep and life quality in patients with chronic obstructive pulmonary disease (COPD). Lack of awareness of night-time symptoms can lead to worsened COPD control. Automated long-term monitoring of respiratory symptoms with LEOSound enables assessment of nocturnal wheezing and cough. METHODS In this observational study we investigated the prevalence and severity of cough and wheezing in patients with stable COPD [Global Initiative for Chronic Obstructive Lung Disease (GOLD) II-IV] disease for two consecutive nights with the LEOSound system. 48 patients (30 males, 63%) were eligible for inclusion, median age was 67 years, and body mass index (BMI) was 25.3 kg/m2. RESULTS In 15 out of 48 patients (31%), we found wheezing periods for at least 10-minute duration. Wheezing periods >30 minutes were monitored in seven patients and wheezing periods >60 minutes were monitored in three patients. The maximum duration of wheezing was 470 minutes in one patient with COPD II. The median wheezing rate differed between the COPD stages and between active and non-active smokers. Cough was found in 42 patients (87.5%) with a range of 1-326 events. The cough-period-index in night one was 0.83 n/hour (P25:0.33||P75: 2.04) and night two 0.97 n/hour (P25:0.25||P75: 1.9). Most of the cough events were non-productive with a median of 0.86. CONCLUSIONS Night-time symptoms are common in COPD patients. LEOSound offers an opportunity to evaluate objectively night-time symptoms like wheezing and cough in patients with COPD which remain otherwise unnoticed. We found a high incidence of night-time wheezing in these patients, which was related to persistant smoking.
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Affiliation(s)
- Johannes Krönig
- a Department of Pneumology, Intensive Care and Sleep Medicine , University Hospital of Marburg and Giessen , Marburg , Germany
| | - Olaf Hildebrandt
- a Department of Pneumology, Intensive Care and Sleep Medicine , University Hospital of Marburg and Giessen , Marburg , Germany
| | | | - Werner Cassel
- a Department of Pneumology, Intensive Care and Sleep Medicine , University Hospital of Marburg and Giessen , Marburg , Germany
| | - Volker Gross
- c Faculty of Health Sciences , University of Applied Sciences , Giessen , Germany
| | - Keywan Sohrabi
- c Faculty of Health Sciences , University of Applied Sciences , Giessen , Germany
| | - Patrick Fischer
- c Faculty of Health Sciences , University of Applied Sciences , Giessen , Germany
| | - Ulrich Koehler
- a Department of Pneumology, Intensive Care and Sleep Medicine , University Hospital of Marburg and Giessen , Marburg , Germany
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Proaño A, Bravard MA, Tracey BH, López JW, Comina G, Zimic M, Coronel J, O'Neill Lee G, Caviedes L, Luis Cabrera J, Salas A, Ticona E, Kirwan DE, Friedland JS, Evans CA, Moore DA, Gilman RH. Protocol for studying cough frequency in people with pulmonary tuberculosis. BMJ Open 2016; 6:e010365. [PMID: 27105713 PMCID: PMC4853990 DOI: 10.1136/bmjopen-2015-010365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Cough is a key symptom of tuberculosis (TB) as well as the main cause of transmission. However, a recent literature review found that cough frequency (number of coughs per hour) in patients with TB has only been studied once, in 1969. The main aim of this study is to describe cough frequency patterns before and after the start of TB treatment and to determine baseline factors that affect cough frequency in these patients. Secondarily, we will evaluate the correlation between cough frequency and TB microbiological resolution. METHODS This study will select participants with culture confirmed TB from 2 tertiary hospitals in Lima, Peru. We estimated that a sample size of 107 patients was sufficient to detect clinically significant changes in cough frequency. Participants will initially be evaluated through questionnaires, radiology, microscopic observation drug susceptibility broth TB-culture, auramine smear microscopy and cough recordings. This cohort will be followed for the initial 60 days of anti-TB treatment, and throughout the study several microbiological samples as well as 24 h recordings will be collected. We will describe the variability of cough episodes and determine its association with baseline laboratory parameters of pulmonary TB. In addition, we will analyse the reduction of cough frequency in predicting TB cure, adjusted for potential confounders. ETHICS AND DISSEMINATION Ethical approval has been obtained from the ethics committees at each participating hospital in Lima, Peru, Asociación Benéfica PRISMA in Lima, Peru, the Universidad Peruana Cayetano Heredia in Lima, Peru and Johns Hopkins University in Baltimore, USA. We aim to publish and disseminate our findings in peer-reviewed journals. We also expect to create and maintain an online repository for TB cough sounds as well as the statistical analysis employed.
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Affiliation(s)
- Alvaro Proaño
- Facultad de Medicina ‘Alberto Hurtado’, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Marjory A Bravard
- Asociación Benéfica PRISMA, Lima, Perú
- Department of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Innovation For Health And Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Brian H Tracey
- Department of Electrical and Computer Engineering, Tufts University, Medford, Massachusetts, USA
| | - José W López
- Instituto Nacional de Salud del Niño San Borja, Lima, Perú
- Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - German Comina
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA
- Escuela Profesional de Ingeniería Física, Facultad de Ciencias, Universidad Nacional de Ingeniería, Lima, Perú
| | - Mirko Zimic
- Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jorge Coronel
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Gwenyth O'Neill Lee
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA
| | - Luz Caviedes
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jose Luis Cabrera
- Servicio de Neumología, Hospital Nacional Alcides Carrión, Lima, Perú
| | - Antonio Salas
- Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Eduardo Ticona
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Daniela E Kirwan
- Infectious Diseases & Immunity, Imperial College London, London, UK
| | - Jon S Friedland
- Infectious Diseases & Immunity, Imperial College London, London, UK
- Wellcome Trust Imperial College Centre for Global Health Research, London, UK
| | - Carlton A Evans
- Innovation For Health And Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
- Infectious Diseases & Immunity, Imperial College London, London, UK
- Wellcome Trust Imperial College Centre for Global Health Research, London, UK
| | - David A Moore
- Asociación Benéfica PRISMA, Lima, Perú
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- TB Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert H Gilman
- Asociación Benéfica PRISMA, Lima, Perú
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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