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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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Serrurier A, Neuschaefer-Rube C, Röhrig R. Past and Trends in Cough Sound Acquisition, Automatic Detection and Automatic Classification: A Comparative Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:2896. [PMID: 35458885 PMCID: PMC9027375 DOI: 10.3390/s22082896] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022]
Abstract
Cough is a very common symptom and the most frequent reason for seeking medical advice. Optimized care goes inevitably through an adapted recording of this symptom and automatic processing. This study provides an updated exhaustive quantitative review of the field of cough sound acquisition, automatic detection in longer audio sequences and automatic classification of the nature or disease. Related studies were analyzed and metrics extracted and processed to create a quantitative characterization of the state-of-the-art and trends. A list of objective criteria was established to select a subset of the most complete detection studies in the perspective of deployment in clinical practice. One hundred and forty-four studies were short-listed, and a picture of the state-of-the-art technology is drawn. The trend shows an increasing number of classification studies, an increase of the dataset size, in part from crowdsourcing, a rapid increase of COVID-19 studies, the prevalence of smartphones and wearable sensors for the acquisition, and a rapid expansion of deep learning. Finally, a subset of 12 detection studies is identified as the most complete ones. An unequaled quantitative overview is presented. The field shows a remarkable dynamic, boosted by the research on COVID-19 diagnosis, and a perfect adaptation to mobile health.
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Affiliation(s)
- Antoine Serrurier
- Institute of Medical Informatics, University Hospital of the RWTH Aachen, 52057 Aachen, Germany;
- Clinic for Phoniatrics, Pedaudiology & Communication Disorders, University Hospital of the RWTH Aachen, 52057 Aachen, Germany;
| | - Christiane Neuschaefer-Rube
- Clinic for Phoniatrics, Pedaudiology & Communication Disorders, University Hospital of the RWTH Aachen, 52057 Aachen, Germany;
| | - Rainer Röhrig
- Institute of Medical Informatics, University Hospital of the RWTH Aachen, 52057 Aachen, Germany;
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3
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Khanam FTZ, Chahl LA, Chahl JS, Al-Naji A, Perera AG, Wang D, Lee Y, Ogunwa TT, Teague S, Nguyen TXB, McIntyre TD, Pegoli SP, Tao Y, McGuire JL, Huynh J, Chahl J. Noncontact Sensing of Contagion. J Imaging 2021; 7:28. [PMID: 34460627 PMCID: PMC8321279 DOI: 10.3390/jimaging7020028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/28/2022] Open
Abstract
The World Health Organization (WHO) has declared COVID-19 a pandemic. We review and reduce the clinical literature on diagnosis of COVID-19 through symptoms that might be remotely detected as of early May 2020. Vital signs associated with respiratory distress and fever, coughing, and visible infections have been reported. Fever screening by temperature monitoring is currently popular. However, improved noncontact detection is sought. Vital signs including heart rate and respiratory rate are affected by the condition. Cough, fatigue, and visible infections are also reported as common symptoms. There are non-contact methods for measuring vital signs remotely that have been shown to have acceptable accuracy, reliability, and practicality in some settings. Each has its pros and cons and may perform well in some challenges but be inadequate in others. Our review shows that visible spectrum and thermal spectrum cameras offer the best options for truly noncontact sensing of those studied to date, thermal cameras due to their potential to measure all likely symptoms on a single camera, especially temperature, and video cameras due to their availability, cost, adaptability, and compatibility. Substantial supply chain disruptions during the pandemic and the widespread nature of the problem means that cost-effectiveness and availability are important considerations.
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Affiliation(s)
- Fatema-Tuz-Zohra Khanam
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
| | - Loris A. Chahl
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW 2308, Australia;
| | - Jaswant S. Chahl
- The Chahl Medical Practice, P.O. Box 2300, Dangar, NSW 2309, Australia;
| | - Ali Al-Naji
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
- Electrical Engineering Technical College, Middle Technical University, Al Doura, Baghdad 10022, Iraq
| | - Asanka G. Perera
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
| | - Danyi Wang
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
| | - Y.H. Lee
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
| | - Titilayo T. Ogunwa
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
| | - Samuel Teague
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
| | - Tran Xuan Bach Nguyen
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
| | - Timothy D. McIntyre
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
| | - Simon P. Pegoli
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
| | - Yiting Tao
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
| | - John L. McGuire
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
| | - Jasmine Huynh
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
| | - Javaan Chahl
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095, Australia; (A.A.-N.); (A.G.P.); (D.W.); (Y.H.L.); (T.T.O.); (S.T.); (T.X.B.N.); (T.D.M.); (S.P.P.); (Y.T.); (J.L.M.); (J.H.); (J.C.)
- Joint and Operations Analysis Division, Defence Science and Technology Group, Melbourne, VIC 3207, Australia
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Grobman M, Lever T, Reinero CR. Discrimination between respiratory and non-respiratory sound waveforms in dogs using acoustic wave recordings: An objective metric of cough. Vet J 2019; 253:105380. [PMID: 31685138 DOI: 10.1016/j.tvjl.2019.105380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 10/26/2022]
Abstract
Cough is an important respiratory protective mechanism, which when persistent also contributes to disease pathology. It is therefore both a marker for and a target of therapeutic intervention. In dogs, assessment of cough is subjective, generally based on owner's perceptions of clinical signs. In humans, acoustic cough monitoring provides objective data on cough frequency by examining acoustic waveforms. We hypothesized that healthy mesocephalic dogs would demonstrate characteristic cough waveforms which could be distinguished from other acoustic behaviors (AB); whine, bark, growl, lick, drink, chew and throat-clear. Data were obtained from 10 healthy employee-owned dogs. Acoustic behaviors were recorded using a CTA-laryngeal-microphone and analyzed using RavenPro bioacoustics software for nine objective acoustic parameters (AP). Similarity between AB were assessed using a one-way analysis of similarity (ANOSIM) with a P<0.001 significance level. Inter- and intra-group statistical analysis was performed using a one-way ANOVA on ranks with P<0.05 significance level. With the exception of throat-clear, cough was dissimilar to every other evaluated AB (P<0.0001), with significant differences in one or more of the analyzed waveform parameters (P<0.001 for each). No between-subject differences were identified between cough and throat-clear groups for any parameter. All other behaviors showed statistically significant within-group variation (P<0.001). Cough and throat-clear (a clinically similar mechanism to protect the airways) have repeatable acoustic features that are distinguishable from other common AB and are consistent between dogs. Acoustic monitoring may provide an objective means for evaluating cough frequency and intensity in dogs with respiratory disease and assessing response to therapeutic intervention.
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Affiliation(s)
- M Grobman
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Auburn University, 1010Wire Road, Auburn, AL, 36849, USA
| | - T Lever
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
| | - C R Reinero
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, 1600 East Rollins, Columbia, MO 65211, USA.
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Hoyos-Barceló C, Monge-Álvarez J, Pervez Z, San-José-Revuelta LM, Casaseca-de-la-Higuera P. Efficient computation of image moments for robust cough detection using smartphones. Comput Biol Med 2018; 100:176-185. [PMID: 30016745 DOI: 10.1016/j.compbiomed.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/04/2018] [Accepted: 07/04/2018] [Indexed: 01/08/2023]
Abstract
Health Monitoring apps for smartphones have the potential to improve quality of life and decrease the cost of health services. However, they have failed to live up to expectation in the context of respiratory disease. This is in part due to poor objective measurements of symptoms such as cough. Real-time cough detection using smartphones faces two main challenges namely, the necessity of dealing with noisy input signals, and the need of the algorithms to be computationally efficient, since a high battery consumption would prevent patients from using them. This paper proposes a robust and efficient smartphone-based cough detection system able to keep the phone battery consumption below 25% (16% if only the detector is considered) during 24 h use. The proposed system efficiently calculates local image moments over audio spectrograms to feed an optimized classifier for final cough detection. Our system achieves 88.94% sensitivity and 98.64% specificity in noisy environments with a 5500× speed-up and 4× battery saving compared to the baseline implementation. Power consumption is also reduced by a minimum factor of 6 compared to existing optimized systems in the literature.
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Affiliation(s)
- Carlos Hoyos-Barceló
- School of Engineering and Computing, University of the West of Scotland, Paisley Campus, High Street, Paisley, PA1 2BE, Scotland, United Kingdom.
| | - Jesús Monge-Álvarez
- School of Engineering and Computing, University of the West of Scotland, Paisley Campus, High Street, Paisley, PA1 2BE, Scotland, United Kingdom.
| | - Zeeshan Pervez
- School of Engineering and Computing, University of the West of Scotland, Paisley Campus, High Street, Paisley, PA1 2BE, Scotland, United Kingdom.
| | - Luis M San-José-Revuelta
- ETSI Telecomunicación, Dpto. Teoría de la Señal y Comunicaciones e Ingeniería Telemática, 47011, Valladolid, Spain.
| | - Pablo Casaseca-de-la-Higuera
- School of Engineering and Computing, University of the West of Scotland, Paisley Campus, High Street, Paisley, PA1 2BE, Scotland, United Kingdom; ETSI Telecomunicación, Dpto. Teoría de la Señal y Comunicaciones e Ingeniería Telemática, 47011, Valladolid, Spain.
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Hirai K, Tabata H, Hirayama M, Kobayashi T, Oh Y, Mochizuki H. A new method for objectively evaluating childhood nocturnal cough. Pediatr Pulmonol 2015; 50:460-8. [PMID: 25641868 DOI: 10.1002/ppul.23125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 05/26/2014] [Accepted: 06/20/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Cough is so common that the best method for evaluating nocturnal cough in children is required. METHODS We developed a cough monitoring system by evaluating 50 child volunteers, and validated the cough monitor in 20 samples from 10 children with cough overnight. Coughs were recorded using a video camera and digital sound recording. At the same time, our system with microphone and accelerometer was used. The number of coughs in each eight hour video-audio recording was counted manually by three trained observers, and all cough data were printed out and the defined cough events, using both these printed-out data and video-audio recordings, were then calculated by three observers. RESULTS The cough monitoring system demonstrated excellent agreement between the number of coughs counted by volunteers, and those counted by cough monitoring system (sensitivity 98.8%, specificity 97.8%). Also, there was significant agreement in the counts of coughs between the video-audio method and our system (P < 0.0001), and between the defined cough events and our system (P < 0.0001). CONCLUSIONS Our method demonstrated well agreement with the video-audio recording method in children, and is considered to be highly useful for the objective monitoring of overnight cough in children with respiratory diseases.
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Affiliation(s)
- Kota Hirai
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Boulet LP, Coeytaux RR, McCrory DC, French CT, Chang AB, Birring SS, Smith J, Diekemper RL, Rubin B, Irwin RS. Tools for assessing outcomes in studies of chronic cough: CHEST guideline and expert panel report. Chest 2015; 147:804-814. [PMID: 25522203 PMCID: PMC5991766 DOI: 10.1378/chest.14-2506] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 11/24/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Since the publication of the 2006 American College of Chest Physicians (CHEST) cough guidelines, a variety of tools has been developed or further refined for assessing cough. The purpose of the present committee was to evaluate instruments used by investigators performing clinical research on chronic cough. The specific aims were to (1) assess the performance of tools designed to measure cough frequency, severity, and impact in adults, adolescents, and children with chronic cough and (2) make recommendations or suggestions related to these findings. METHODS By following the CHEST methodologic guidelines, the CHEST Expert Cough Panel based its recommendations and suggestions on a recently published comparative effectiveness review commissioned by the US Agency for Healthcare Research and Quality, a corresponding summary published in CHEST, and an updated systematic review through November 2013. Recommendations or suggestions based on these data were discussed, graded, and voted on during a meeting of the Expert Cough Panel. RESULTS We recommend for adults, adolescents (≥ 14 years of age), and children complaining of chronic cough that validated and reliable health-related quality-of-life (QoL) questionnaires be used as the measurement of choice to assess the impact of cough, such as the Leicester Cough Questionnaire and the Cough-Specific Quality-of-Life Questionnaire in adult and adolescent patients and the Parent Cough-Specific Quality of Life Questionnaire in children. We recommend acoustic cough counting to assess cough frequency but not cough severity. Limited data exist regarding the performance of visual analog scales, numeric rating scales, and tussigenic challenges. CONCLUSIONS Validated and reliable cough-specific health-related QoL questionnaires are recommended as the measurement of choice to assess the impact of cough on patients. How they compare is yet to be determined. When used, the reporting of cough severity by visual analog or numeric rating scales should be standardized. Previously validated QoL questionnaires or other cough assessments should not be modified unless the new version has been shown to be reliable and valid. Finally, in research settings, tussigenic challenges play a role in understanding mechanisms of cough.
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Key Words
- ahrq, agency for healthcare research and quality
- cb, consensus-based
- cer, comparative effectiveness review
- chest, american college of chest physicians
- coi, conflict of interest
- cqlq, cough-specific quality-of-life questionnaire
- lcq, leicester cough questionnaire
- pcq, pediatric cough questionnaire
- pc-qol, parent cough-specific quality of life questionnaire
- picots, population of interest, interventions, comparators, outcomes, timing of outcomes, and settings
- qol, quality of life
- vas, visual analog scale
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Affiliation(s)
- Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, QC, Canada.
| | - Remy R Coeytaux
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC
| | - Douglas C McCrory
- Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC
| | - Cynthia T French
- Pulmonary, Allergy and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA
| | - Anne B Chang
- Department of Respiratory Medicine, Royal Children's Hospital, Herston, QLD, Australia
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, England
| | - Jaclyn Smith
- University Hospital of South Manchester, Manchester, England
| | | | - Bruce Rubin
- Virginia Commonwealth University, Richmond, VA
| | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
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Abstract
The development of an Automated System for Asthma Monitoring (ADAM) is described. This consists of a consumer electronics mobile platform running a custom application. The application acquires an audio signal from an external user-worn microphone connected to the device analog-to-digital converter (microphone input). This signal is processed to determine the presence or absence of cough sounds. Symptom tallies and raw audio waveforms are recorded and made easily accessible for later review by a healthcare provider. The symptom detection algorithm is based upon standard speech recognition and machine learning paradigms and consists of an audio feature extraction step followed by a Hidden Markov Model based Viterbi decoder that has been trained on a large database of audio examples from a variety of subjects. Multiple Hidden Markov Model topologies and orders are studied. Performance of the recognizer is presented in terms of the sensitivity and the rate of false alarm as determined in a cross-validation test.
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9
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Silverman EP, Carnaby-Mann G, Pitts T, Davenport P, Okun MS, Sapienza C. Concordance and discriminatory power of cough measurement devices for individuals with Parkinson disease. Chest 2014; 145:1089-1096. [PMID: 24264124 DOI: 10.1378/chest.13-0596] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dysphagia and aspiration pneumonia are two causes of morbidity in Parkinson disease (PD). In PD, impaired airway clearance can lead to penetration of foreign material, resulting in a high prevalence of aspiration pneumonia and death. This study examines three different devices for measurement of peak airflow during voluntary cough in healthy control subjects and those with PD. Two simple and low-cost devices for measuring peak cough airflow were compared with the "gold standard" pneumotachograph. METHODS Thirty-five healthy control subjects and 35 individuals with PD produced voluntary cough at three perceived strengths (weak, moderate, and strong cough) for each of the three devices. RESULTS A significant difference in mean peak cough airflow was demonstrated for disease (F[1,56] = 4.0, P < .05) and sex (F[1,56] = 9.59, P < .003) across devices. The digital and analog meters were comparable to the gold standard demonstrating no significant difference (statistical) by device (digital vs analog) in receiver operating characteristic curve analysis. Both devices were discriminative of the presence of PD. CONCLUSIONS The analog and digital peak airflow meters are suitable alternatives to the gold standard pneumotachograph due to their low cost, portability, ease of use, and high sensitivity relative to normative peak cough airflows. Voluntary cough airflow measures may serve as a noninvasive means of screening for aspiration risk in target populations. Additionally, quantification of cough strength through use of predetermined limens for weak, moderate, and strong cough may assist clinicians in better describing and tracking cough strength as a contributing factor to aspiration risk.
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Affiliation(s)
- Erin P Silverman
- Brain Rehabilitation and Research Center, Malcom Randall VA Medical Center, Gainesville; Department of Physiological Sciences, Center for Movements Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville.
| | - Giselle Carnaby-Mann
- College of Veterinary Medicine, Department of Behavioral Science and Community Health, Center for Movements Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville
| | - Teresa Pitts
- Department of Physiological Sciences, Center for Movements Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville
| | - Paul Davenport
- Department of Physiological Sciences, Center for Movements Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville
| | - Michael S Okun
- College of Public Health and Health Professions, and Departments of Neurology and Neurosurgery, Center for Movements Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville
| | - Christine Sapienza
- Department of Physiological Sciences, Center for Movements Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville; Department of Communication Sciences and Disorders, College of Health Sciences, Jacksonville University, Jacksonville, FL
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10
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Schmit KM, Coeytaux RR, Goode AP, McCrory DC, Yancy WS, Kemper AR, Hasselblad V, Heidenfelder BL, Sanders GD. Evaluating cough assessment tools: a systematic review. Chest 2014; 144:1819-1826. [PMID: 23928647 DOI: 10.1378/chest.13-0310] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Little is known about the comparative validity, reliability, or responsiveness of instruments for assessing cough frequency or impact, where the term impact encompasses both cough severity and the impact of cough on health-related quality of life. METHODS We conducted a systematic review to evaluate instruments that assess cough frequency or impact in adults, adolescents, and children with acute or chronic cough. RESULTS Seventy-eight studies were included, of which eight were randomized controlled trials and 70 were observational studies. In all age groups, audio and video electronic recording devices had good reliability compared with other methods of assessing cough frequency but had variable correlation with other cough assessments, such as visual analog scale scores, quality-of-life questionnaires, cough diaries, and tussigenic challenges. Among adult and adolescent patients, the Leicester Cough Questionnaire (LCQ) and the Cough-Specific Quality-of-Life Questionnaire (CQLQ) were valid and reliable, showing high intraclass and test-retest correlations. Among children, the Parent Cough-Specific Quality of Life Questionnaire and Pediatric Cough Questionnaire were valid and reliable. CONCLUSIONS Electronic recording devices can be valid assessments of cough frequency. The LCQ and CQLQ for adults and the Parent Cough-Specific Quality of Life questionnaire for children are valid instruments for assessing cough impact. There is limited but insufficient evidence to determine the reliability or concurrent validity of the different types of cough diaries or visual analog scale scores. There are also limited data to support the responsiveness of recording devices. There is good responsiveness data for the LCQ and CQLQ, but more evidence is needed.
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Affiliation(s)
- Kristine M Schmit
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC.
| | - Remy R Coeytaux
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC; Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC
| | - Adam P Goode
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC
| | - Douglas C McCrory
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC; Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC
| | - William S Yancy
- Department of Medicine, Duke University School of Medicine, Durham, NC; Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC
| | - Alex R Kemper
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Vic Hasselblad
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Brooke L Heidenfelder
- Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC
| | - Gillian D Sanders
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC
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