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Chung KF, Chaccour C, Jover L, Galvosas M, Song WJ, Rudd M, Small P. Longitudinal Cough Frequency Monitoring in Persistent Coughers: Daily Variability and Predictability. Lung 2024; 202:561-568. [PMID: 39085518 PMCID: PMC11427503 DOI: 10.1007/s00408-024-00734-x] [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: 06/07/2024] [Accepted: 07/21/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE We determined the cough counts and their variability in subjects with persistent cough for 30 days. METHODS The Hyfe cough tracker app uses the mobile phone microphone to monitor sounds and recognizes cough with artificial intelligence-enabled algorithms. We analyzed the daily cough counts including the daily predictability rates of 97 individuals who monitored their coughs over 30 days and had a daily cough rate of at least 5 coughs per hour. RESULTS The mean (median) daily cough rates varied from 6.5 to 182 (6.2 to 160) coughs per hour, with standard deviations (interquartile ranges) varying from 0.99 to 124 (1.30 to 207) coughs per hour among all subjects. There was a positive association between cough rate and variability, as subjects with higher mean cough rates (OLS) have larger standard deviations. The accuracy of any given day for predicting all 30 days is the One Day Predictability for that day, defined as the percentage of days when cough frequencies fall within that day's 95% confidence interval. Overall Predictability was the mean of the 30-One Day Predictability percentages and ranged from 95% (best predictability) to 30% (least predictability). CONCLUSION There is substantial within-day and day-to-day variability for each subject with persistent cough recorded over 30 days. If confirmed in future studies, the clinical significance and the impact on the use of cough counts as a primary end-point of cough interventions of this variability need to be assessed.
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Affiliation(s)
- Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, Dovehouse St, London, SW3 6LY, UK.
| | - Carlos Chaccour
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Clinica Universidad de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | | | | | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Matthew Rudd
- Hyfe Inc., Wilmington, DE, USA
- University of the South, Sewanee, TN, USA
| | - Peter Small
- Hyfe Inc., Wilmington, DE, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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2
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Zimmer AJ, Tsang LY, Jolicoeur G, Tannir B, Batisse E, Pando C, Sadananda G, McKinney J, Ambinintsoa IV, Rabetombosoa RM, Knoblauch AM, Rakotosamimanana N, Chartier R, Diachenko A, Small P, Grandjean Lapierre S. Incidence of cough from acute exposure to fine particulate matter (PM2.5) in Madagascar: A pilot study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003530. [PMID: 39058715 PMCID: PMC11280240 DOI: 10.1371/journal.pgph.0003530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024]
Abstract
Prolonged exposure to fine particulate matter (PM2.5) is a known risk to respiratory health, causing chronic lung impairment. Yet, the immediate, acute effects of PM2.5 exposure on respiratory symptoms, such as cough, are less understood. This pilot study aims to investigate this relationship using objective PM2.5 and cough monitors. Fifteen participants from rural Madagascar were followed for three days, equipped with an RTI Enhanced Children's MicroPEM PM2.5 sensor and a smartphone with the ResApp Cough Counting Software application. Univariable Generalized Estimating Equation (GEE) models were applied to measure the association between hourly PM2.5 exposure and cough counts. Peaks in both PM2.5 concentration and cough frequency were observed during the day. A 10-fold increase in hourly PM2.5 concentration corresponded to a 39% increase in same-hour cough frequency (incidence rate ratio (IRR) = 1.40; 95% CI: 1.12, 1.74). The strength of this association decreased with a one-hour lag between PM2.5 exposure and cough frequency (IRR = 1.21; 95% CI: 1.01, 1.44) and was not significant with a two-hour lag (IRR = 0.93; 95% CI: 0.71, 1.23). This study demonstrates the feasibility of objective PM2.5 and cough monitoring in remote settings. An association between hourly PM2.5 exposure and cough frequency was detected, suggesting that PM2.5 exposure may have immediate effects on respiratory health. Further investigation is necessary in larger studies to substantiate these findings and understand the broader implications.
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Affiliation(s)
- Alexandra J. Zimmer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, McGill University, Montreal, Canada
| | - Lai Yu Tsang
- Global Health Institute, Stony Brook University, Stony Brook, New York, United States of America
| | - Gisèle Jolicoeur
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montreal, Montreal, Canada
| | - Bouchra Tannir
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montreal, Montreal, Canada
| | - Emmanuelle Batisse
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Christine Pando
- Global Health Institute, Stony Brook University, Stony Brook, New York, United States of America
| | - Gouri Sadananda
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Jesse McKinney
- Global Health Institute, Stony Brook University, Stony Brook, New York, United States of America
- Centre ValBio Research Station, Ranomafana, Madagascar
| | | | | | - Astrid M. Knoblauch
- Mycobacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Department of epidemiology and public health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Department of Public Health, University of Basel, Basel, Switzerland
| | | | - Ryan Chartier
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Alina Diachenko
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montreal, Montreal, Canada
| | - Peter Small
- Global Health Institute, Stony Brook University, Stony Brook, New York, United States of America
| | - Simon Grandjean Lapierre
- McGill International TB Centre, McGill University, Montreal, Canada
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montreal, Montreal, Canada
- Mycobacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada
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3
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Isangula KG, Haule RJ. Leveraging AI and Machine Learning to Develop and Evaluate a Contextualized User-Friendly Cough Audio Classifier for Detecting Respiratory Diseases: Protocol for a Diagnostic Study in Rural Tanzania. JMIR Res Protoc 2024; 13:e54388. [PMID: 38652526 PMCID: PMC11077412 DOI: 10.2196/54388] [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: 11/08/2023] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Respiratory diseases, including active tuberculosis (TB), asthma, and chronic obstructive pulmonary disease (COPD), constitute substantial global health challenges, necessitating timely and accurate diagnosis for effective treatment and management. OBJECTIVE This research seeks to develop and evaluate a noninvasive user-friendly artificial intelligence (AI)-powered cough audio classifier for detecting these respiratory conditions in rural Tanzania. METHODS This is a nonexperimental cross-sectional research with the primary objective of collection and analysis of cough sounds from patients with active TB, asthma, and COPD in outpatient clinics to generate and evaluate a noninvasive cough audio classifier. Specialized cough sound recording devices, designed to be nonintrusive and user-friendly, will facilitate the collection of diverse cough sound samples from patients attending outpatient clinics in 20 health care facilities in the Shinyanga region. The collected cough sound data will undergo rigorous analysis, using advanced AI signal processing and machine learning techniques. By comparing acoustic features and patterns associated with TB, asthma, and COPD, a robust algorithm capable of automated disease discrimination will be generated facilitating the development of a smartphone-based cough sound classifier. The classifier will be evaluated against the calculated reference standards including clinical assessments, sputum smear, GeneXpert, chest x-ray, culture and sensitivity, spirometry and peak expiratory flow, and sensitivity and predictive values. RESULTS This research represents a vital step toward enhancing the diagnostic capabilities available in outpatient clinics, with the potential to revolutionize the field of respiratory disease diagnosis. Findings from the 4 phases of the study will be presented as descriptions supported by relevant images, tables, and figures. The anticipated outcome of this research is the creation of a reliable, noninvasive diagnostic cough classifier that empowers health care professionals and patients themselves to identify and differentiate these respiratory diseases based on cough sound patterns. CONCLUSIONS Cough sound classifiers use advanced technology for early detection and management of respiratory conditions, offering a less invasive and more efficient alternative to traditional diagnostics. This technology promises to ease public health burdens, improve patient outcomes, and enhance health care access in under-resourced areas, potentially transforming respiratory disease management globally. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54388.
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Affiliation(s)
- Kahabi Ganka Isangula
- School of Nursing and Midwifery, Aga Khan University, Dar Es Salaam, United Republic of Tanzania
| | - Rogers John Haule
- School of Nursing and Midwifery, Aga Khan University, Dar Es Salaam, United Republic of Tanzania
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Ghrabli S, Elgendi M, Menon C. Identifying unique spectral fingerprints in cough sounds for diagnosing respiratory ailments. Sci Rep 2024; 14:593. [PMID: 38182601 PMCID: PMC10770161 DOI: 10.1038/s41598-023-50371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
Coughing, a prevalent symptom of many illnesses, including COVID-19, has led researchers to explore the potential of cough sound signals for cost-effective disease diagnosis. Traditional diagnostic methods, which can be expensive and require specialized personnel, contrast with the more accessible smartphone analysis of coughs. Typically, coughs are classified as wet or dry based on their phase duration. However, the utilization of acoustic analysis for diagnostic purposes is not widespread. Our study examined cough sounds from 1183 COVID-19-positive patients and compared them with 341 non-COVID-19 cough samples, as well as analyzing distinctions between pneumonia and asthma-related coughs. After rigorous optimization across frequency ranges, specific frequency bands were found to correlate with each respiratory ailment. Statistical separability tests validated these findings, and machine learning algorithms, including linear discriminant analysis and k-nearest neighbors classifiers, were employed to confirm the presence of distinct frequency bands in the cough signal power spectrum associated with particular diseases. The identification of these acoustic signatures in cough sounds holds the potential to transform the classification and diagnosis of respiratory diseases, offering an affordable and widely accessible healthcare tool.
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Affiliation(s)
- Syrine Ghrabli
- Biomedical and Mobile Health Technology Lab, ETH Zurich, 8008, Zurich, Switzerland
- Department of Physics, ETH Zurich, 8093, Zurich, Switzerland
| | - Mohamed Elgendi
- Biomedical and Mobile Health Technology Lab, ETH Zurich, 8008, Zurich, Switzerland.
| | - Carlo Menon
- Biomedical and Mobile Health Technology Lab, ETH Zurich, 8008, Zurich, Switzerland.
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5
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Saeed T, Ijaz A, Sadiq I, Qureshi HN, Rizwan A, Imran A. An AI-Enabled Bias-Free Respiratory Disease Diagnosis Model Using Cough Audio. Bioengineering (Basel) 2024; 11:55. [PMID: 38247932 PMCID: PMC10813025 DOI: 10.3390/bioengineering11010055] [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: 11/28/2023] [Revised: 12/25/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Cough-based diagnosis for respiratory diseases (RDs) using artificial intelligence (AI) has attracted considerable attention, yet many existing studies overlook confounding variables in their predictive models. These variables can distort the relationship between cough recordings (input data) and RD status (output variable), leading to biased associations and unrealistic model performance. To address this gap, we propose the Bias-Free Network (RBF-Net), an end-to-end solution that effectively mitigates the impact of confounders in the training data distribution. RBF-Net ensures accurate and unbiased RD diagnosis features, emphasizing its relevance by incorporating a COVID-19 dataset in this study. This approach aims to enhance the reliability of AI-based RD diagnosis models by navigating the challenges posed by confounding variables. A hybrid of a Convolutional Neural Networks (CNN) and Long Short-Term Memory (LSTM) networks is proposed for the feature encoder module of RBF-Net. An additional bias predictor is incorporated in the classification scheme to formulate a conditional Generative Adversarial Network (c-GAN) that helps in decorrelating the impact of confounding variables from RD prediction. The merit of RBF-Net is demonstrated by comparing classification performance with a State-of-The-Art (SoTA) Deep Learning (DL) model (CNN-LSTM) after training on different unbalanced COVID-19 data sets, created by using a large-scale proprietary cough data set. RBF-Net proved its robustness against extremely biased training scenarios by achieving test set accuracies of 84.1%, 84.6%, and 80.5% for the following confounding variables-gender, age, and smoking status, respectively. RBF-Net outperforms the CNN-LSTM model test set accuracies by 5.5%, 7.7%, and 8.2%, respectively.
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Affiliation(s)
- Tabish Saeed
- AI4Networks Research Center, Department of Electrical & Computer Engineering, University of Oklahoma, Tulsa, OK 74135, USA; (H.N.Q.); (A.I.)
| | - Aneeqa Ijaz
- AI4Networks Research Center, Department of Electrical & Computer Engineering, University of Oklahoma, Tulsa, OK 74135, USA; (H.N.Q.); (A.I.)
| | - Ismail Sadiq
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Haneya Naeem Qureshi
- AI4Networks Research Center, Department of Electrical & Computer Engineering, University of Oklahoma, Tulsa, OK 74135, USA; (H.N.Q.); (A.I.)
| | - Ali Rizwan
- AI4lyf, Bahria Town Lahore, Lahore 54000, Pakistan;
| | - Ali Imran
- AI4Networks Research Center, Department of Electrical & Computer Engineering, University of Oklahoma, Tulsa, OK 74135, USA; (H.N.Q.); (A.I.)
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK;
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Jakusova J, Brozmanova M. Methods of Cough Assessment and Objectivization. Physiol Res 2023; 72:687-700. [PMID: 38215057 PMCID: PMC10805254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 09/18/2023] [Indexed: 01/14/2024] Open
Abstract
Cough is one of the most important airway defensive reflexes aimed at removing foreign particles or endogenously produced materials from the airways and provides protection against aspiration. Generally considered, cough is a vital physiological defensive mechanism for lung health. However, in case of cough dysregulation this reflex can become pathological and leads to an adverse influence on daily life. Therefore, it is necessary to effectively evaluate the severity of cough for its diagnosis and treatment. There are subjective and objective methods for assessing cough. These methods should help describe the heterogeneity of cough phenotypes and may establish better treatment by monitoring response to nonpharmacological or pharmacological therapies. It is important to keep in mind that the clinical assessment of cough should include both tools that measure the amount and severity of the cough. The importance of a combined subjective and objective evaluation for a comprehensive assessment of cough has been advocated in the guidelines of the European Respiratory Society on cough evaluation. This review article provides an overview of subjective and objective methods for assessing and monitoring cough in children and adults comparing to animal models. Key words Cough frequency; Cough intensity; Cough reflex sensitivity; Cough monitors; Cough assessment.
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Affiliation(s)
- J Jakusova
- Department of Pathological Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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Cummerow J, Wienecke C, Engler N, Marahrens P, Gruening P, Steinhäuser J. Identifying Existing Evidence to Potentially Develop a Machine Learning Diagnostic Algorithm for Cough in Primary Care Settings: Scoping Review. J Med Internet Res 2023; 25:e46929. [PMID: 38096024 PMCID: PMC10755665 DOI: 10.2196/46929] [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: 03/06/2023] [Revised: 07/19/2023] [Accepted: 10/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Primary care is known to be one of the most complex health care settings because of the high number of theoretically possible diagnoses. Therefore, the process of clinical decision-making in primary care includes complex analytical and nonanalytical factors such as gut feelings and dealing with uncertainties. Artificial intelligence is also mandated to offer support in finding valid diagnoses. Nevertheless, to translate some aspects of what occurs during a consultation into a machine-based diagnostic algorithm, the probabilities for the underlying diagnoses (odds ratios) need to be determined. OBJECTIVE Cough is one of the most common reasons for a consultation in general practice, the core discipline in primary care. The aim of this scoping review was to identify the available data on cough as a predictor of various diagnoses encountered in general practice. In the context of an ongoing project, we reflect on this database as a possible basis for a machine-based diagnostic algorithm. Furthermore, we discuss the applicability of such an algorithm against the background of the specifics of general practice. METHODS The PubMed, Scopus, Web of Science, and Cochrane Library databases were searched with defined search terms, supplemented by the search for gray literature via the German Journal of Family Medicine until April 20, 2023. The inclusion criterion was the explicit analysis of cough as a predictor of any conceivable disease. Exclusion criteria were articles that did not provide original study results, articles in languages other than English or German, and articles that did not mention cough as a diagnostic predictor. RESULTS In total, 1458 records were identified for screening, of which 35 articles met our inclusion criteria. Most of the results (11/35, 31%) were found for chronic obstructive pulmonary disease. The others were distributed among the diagnoses of asthma or unspecified obstructive airway disease, various infectious diseases, bronchogenic carcinoma, dyspepsia or gastroesophageal reflux disease, and adverse effects of angiotensin-converting enzyme inhibitors. Positive odds ratios were found for cough as a predictor of chronic obstructive pulmonary disease, influenza, COVID-19 infections, and bronchial carcinoma, whereas the results for cough as a predictor of asthma and other nonspecified obstructive airway diseases were inconsistent. CONCLUSIONS Reliable data on cough as a predictor of various diagnoses encountered in general practice are scarce. The example of cough does not provide a sufficient database to contribute odds to a machine learning-based diagnostic algorithm in a meaningful way.
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Affiliation(s)
- Julia Cummerow
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Christin Wienecke
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Nicola Engler
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Philip Marahrens
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Philipp Gruening
- Institute for Neuro- and Bioinformatics, University of Lübeck, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Parker SM, Smith JA, Birring SS, Chamberlain-Mitchell S, Gruffydd-Jones K, Haines J, Hennessey S, McGarvey LP, Marsden P, Martin MJ, Morice A, O'Hara J, Thomas M. British Thoracic Society Clinical Statement on chronic cough in adults. Thorax 2023; 78:s3-s19. [PMID: 38088193 DOI: 10.1136/thorax-2023-220592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Sean M Parker
- Department of Respiratory Medicine, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Jaclyn Ann Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Surinder S Birring
- Department of Respiratory Medicine, Kings College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - Jemma Haines
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | | | - Paul Marsden
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | - Alyn Morice
- Castle Hill Hospital, Cottingham, UK
- University of Hull, Hull, UK
| | - James O'Hara
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Mike Thomas
- Academic Unit of Primary Care and Population Science, University of Southampton, Southampton, UK
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Sanchez-Olivieri I, Rudd M, Gabaldon-Figueira JC, Carmona-Torre F, Del Pozo JL, Moorsmith R, Jover L, Galvosas M, Small P, Grandjean Lapierre S, Chaccour C. Performance evaluation of human cough annotators: optimal metrics and sex differences. BMJ Open Respir Res 2023; 10:e001942. [PMID: 37945314 PMCID: PMC10649781 DOI: 10.1136/bmjresp-2023-001942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Despite its high prevalence and significance, there is still no widely available method to quantify cough. In order to demonstrate agreement with the current gold standard of human annotation, emerging automated techniques require a robust, reproducible approach to annotation. We describe the extent to which a human annotator of cough sounds (a) agrees with herself (intralabeller or intrarater agreement) and (b) agrees with other independent labellers (interlabeller or inter-rater agreement); we go on to describe significant sex differences in cough sound length and epochs size. MATERIALS AND METHODS 24 participants wore an audiorecording smartwatch to capture 6-24 hours of continuous audio. A randomly selected sample of the whole audio was labelled twice by an expert annotator and a third time by six trained annotators. We collected 400 hours of audio and analysed 40 hours. The cough counts as well as cough seconds (any 1 s of time containing at least one cough) from different annotators were compared and summary statistics from linear and Bland-Altman analyses were used to quantify intraobserver and interobserver agreement. RESULTS There was excellent intralabeller (less than two disagreements per hour monitored, Pearson's correlation 0.98) and interlabeller agreement (Pearson's correlation 0.96), using cough seconds as the unit of analysis decreased annotator discrepancies by 50% in comparison to coughs. Within this data set, it was observed that the length of cough sounds and epoch size (number of coughs per bout or attach) differed between women and men. CONCLUSION Given the decreased interobserver variability in annotation when using cough seconds (vs just coughs) we propose their use for manually annotating cough when assessing of the performance of automatic cough monitoring systems. The differences in cough sound length and epochs size may have important implications for equality in the development of cough monitoring tools. TRIAL REGISTRATION NUMBER NCT05042063.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Simon Grandjean Lapierre
- Dept of Microbiology, Infectious Diseases and Immunology, Research Center of the University of Montreal Hospital Center, Montreal, Quebec, Canada
- Immunopathology Axis, Research Center of the University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Carlos Chaccour
- Universidad de Navarra, Pamplona, Spain
- ISGlobal, Barcelona institute for Global Health, Barcelona, Spain
- Centro de investigación biomédica en red enfermedades infecciosas, Madrid, Spain
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10
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Shim JS, Kim BK, Kim SH, Kwon JW, Ahn KM, Kang SY, Park HK, Park HW, Yang MS, Kim MH, Lee SM. A smartphone-based application for cough counting in patients with acute asthma exacerbation. J Thorac Dis 2023; 15:4053-4065. [PMID: 37559656 PMCID: PMC10407484 DOI: 10.21037/jtd-22-1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/19/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND While tools exist for objective cough counting in clinical studies, there is no available tool for objective cough measurement in clinical practice. An artificial intelligence (AI)-based cough count system was recently developed that quantifies cough sounds collected through a smartphone application. In this prospective study, this AI-based cough algorithm was applied among real-world patients with an acute exacerbation of asthma. METHODS Patients with an acute asthma exacerbation recorded their cough sounds for 7 days (2 consecutive hours during awake time and 5 consecutive hours during sleep) using CoughyTM smartphone application. During the study period, subjects received systemic corticosteroids and bronchodilator to control asthma. Coughs collected by application were counted by both the AI algorithm and two human experts. Subjects also provided self-measured peak expiratory flow rate (PEFR) and completed other outcome assessments [e.g., cough symptom visual analogue scale (CS-VAS), awake frequency, salbutamol use] to investigate the correlation between cough and other parameters. RESULTS A total of 1,417.6 h of cough recordings were obtained from 24 asthmatics (median age =39 years). Cough counts by AI were strongly correlated with manual cough counts during sleep time (rho =0.908, P<0.001) and awake time (rho =0.847, P<0.001). Sleep time cough counts were moderately to strongly correlated with CS-VAS (rho =0.339, P<0.001), the frequency of waking up (rho =0.462, P<0.001), and salbutamol use at night (rho =0.243, P<0.001). Weak-to-moderate correlations were found between awake time cough counts and CS-VAS (rho =0.313, P<0.001), the degree of activity limitation (rho =0.169, P=0.005), and salbutamol use at awake time (rho =0.276, P<0.001). Neither awake time nor sleep time cough counts were significantly correlated with PEFR. CONCLUSIONS The strong correlation between cough counts using the AI-based algorithm and human experts, and other indicators of patient health status provides evidence of the validity of this AI algorithm for use in asthma patients experiencing an acute exacerbation. Study findings suggest that CoughyTM could be a novel solution for objectively monitoring cough in a clinical setting.
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Affiliation(s)
- Ji-Su Shim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Byung-Keun Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Kyung-Min Ahn
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Han-Ki Park
- Department of Allergy and Clinical Immunology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min-Suk Yang
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Orlandic L, Thevenot J, Teijeiro T, Atienza D. A Multimodal Dataset for Automatic Edge-AI Cough Detection. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-7. [PMID: 38082667 DOI: 10.1109/embc40787.2023.10340413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Counting the number of times a patient coughs per day is an essential biomarker in determining treatment efficacy for novel antitussive therapies and personalizing patient care. Automatic cough counting tools must provide accurate information, while running on a lightweight, portable device that protects the patient's privacy. Several devices and algorithms have been developed for cough counting, but many use only error-prone audio signals, rely on offline processing that compromises data privacy, or utilize processing and memory-intensive neural networks that require more hardware resources than can fit on a wearable device. Therefore, there is a need for wearable devices that employ multimodal sensors to perform accurate, privacy-preserving, automatic cough counting algorithms directly on the device in an edge Artificial Intelligence (edge-AI) fashion. To advance this research field, we contribute the first publicly accessible cough counting dataset of multimodal biosignals. The database contains nearly 4 hours of biosignal data, with both acoustic and kinematic modalities, covering 4,300 annotated cough events from 15 subjects. Furthermore, a variety of non-cough sounds and motion scenarios mimicking daily life activities are also present, which the research community can use to accelerate machine learning (ML) algorithm development. A technical validation of the dataset reveals that it represents a wide variety of signal-to-noise ratios, which can be expected in a real-life use case, as well as consistency across experimental trials. Finally, to demonstrate the usability of the dataset, we train a simple cough vs non-cough signal classifier that obtains a 91% sensitivity, 92% specificity, and 80% precision on unseen test subject data. Such edge-friendly AI algorithms have the potential to provide continuous ambulatory monitoring of the numerous chronic cough patients.
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Jose L, Berkovsky S, Xiong H, Mascolo C, Sharan RV. Denoising Cough Sound Recordings Using Neural Networks . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082867 DOI: 10.1109/embc40787.2023.10340687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objective cough sound evaluation is useful in the diagnosis and management of respiratory diseases. However, the performance of cough sound analysis models can degrade in the presence of background noises common in everyday environments. This brings forward the need for cough sound denoising. This work utilizes a method for denoising cough sound recordings using signal processing and machine learning techniques, inspired by research in the field of speech enhancement. It uses supervised learning to find a mapping between the noisy and clean spectra of cough sound signals using a fully connected feed-forward neural network. The method is validated on a dataset of 300 manually annotated cough sound recordings corrupted with babble noise. The effect of various signal processing and neural network parameters on denoising performance is investigated. The method is shown to improve cough sound quality and intelligibility and outperform conventional denoising methods.
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Kraman SS, Pasterkamp H, Wodicka GR. Smart Devices Are Poised to Revolutionize the Usefulness of Respiratory Sounds. Chest 2023; 163:1519-1528. [PMID: 36706908 PMCID: PMC10925548 DOI: 10.1016/j.chest.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
The association between breathing sounds and respiratory health or disease has been exceptionally useful in the practice of medicine since the advent of the stethoscope. Remote patient monitoring technology and artificial intelligence offer the potential to develop practical means of assessing respiratory function or dysfunction through continuous assessment of breathing sounds when patients are at home, at work, or even asleep. Automated reports such as cough counts or the percentage of the breathing cycles containing wheezes can be delivered to a practitioner via secure electronic means or returned to the clinical office at the first opportunity. This has not previously been possible. The four respiratory sounds that most lend themselves to this technology are wheezes, to detect breakthrough asthma at night and even occupational asthma when a patient is at work; snoring as an indicator of OSA or adequacy of CPAP settings; cough in which long-term recording can objectively assess treatment adequacy; and crackles, which, although subtle and often overlooked, can contain important clinical information when appearing in a home recording. In recent years, a flurry of publications in the engineering literature described construction, usage, and testing outcomes of such devices. Little of this has appeared in the medical literature. The potential value of this technology for pulmonary medicine is compelling. We expect that these tiny, smart devices soon will allow us to address clinical questions that occur away from the clinic.
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Affiliation(s)
- Steve S Kraman
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY.
| | - Hans Pasterkamp
- University of Manitoba, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - George R Wodicka
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
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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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15
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Davidson C, Caguana OA, Lozano-García M, Arita Guevara M, Estrada-Petrocelli L, Ferrer-Lluis I, Castillo-Escario Y, Ausín P, Gea J, Jané R. Differences in acoustic features of cough by pneumonia severity in patients with COVID-19: a cross-sectional study. ERJ Open Res 2023; 9:00247-2022. [PMID: 37131524 PMCID: PMC9922471 DOI: 10.1183/23120541.00247-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 01/07/2023] [Indexed: 02/05/2023] Open
Abstract
BackgroundAcute respiratory syndrome due to coronavirus 2 (SARS-CoV-2) is characterised by heterogeneous levels of disease severity. It is not necessarily apparent whether a patient will develop a severe disease or not. This cross-sectional study explores whether acoustic properties of the cough sound of patients with coronavirus disease (COVID-19), the illness caused by SARS-CoV-2, correlate with their disease and pneumonia severity, with the aim of identifying patients with a severe disease.MethodsVoluntary cough sounds were recorded using a smartphone in 70 COVID-19 patients within the first 24 h of their hospital arrival, between April 2020 and May 2021. Based on gas exchange abnormalities, patients were classified as mild, moderate, or severe. Time- and frequency-based variables were obtained from each cough effort and analysed using a linear mixed-effects modelling approach.ResultsRecords from 62 patients (37% female) were eligible for inclusion in the analysis, with mild, moderate, and severe groups consisting of 31, 14 and 17 patients respectively. 5 of the parameters examined were found to be significantly different in the cough of patients at different disease levels of severity, with a further 2 parameters found to be affected differently by the disease severity in men and women.ConclusionsWe suggest that all these differences reflect the progressive pathophysiological alterations occurring in the respiratory system of COVID-19 patients, and potentially would provide an easy and cost-effective way to initially stratify patients, identifying those with more severe disease, and thereby most effectively allocate healthcare resources.
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16
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Shim JS, Kim MH, Lee SM, Kim SH, Kwon JW, Song C, Ahn KM, Kang SY, Park HK, Park HW, Kim BK, Yang MS. An artificial intelligence algorithm-based smartphone application for daily cough monitoring. Allergy 2023; 78:1378-1380. [PMID: 36588171 DOI: 10.1111/all.15632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Ji-Su Shim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | | | - Kyung-Min Ahn
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Han-Ki Park
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung-Keun Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min-Suk Yang
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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17
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Lalouani W, Younis M, Emokpae RN, Emokpae LE. Enabling effective breathing sound analysis for automated diagnosis of lung diseases. SMART HEALTH 2022; 26:100329. [PMID: 36275046 PMCID: PMC9576264 DOI: 10.1016/j.smhl.2022.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/21/2022] [Accepted: 09/29/2022] [Indexed: 10/29/2022]
Abstract
With the emergence of the COVID-19 pandemic, early diagnosis of lung diseases has attracted growing attention. Generally, monitoring the breathing sound is the traditional means for assessing the status of a patient's respiratory health through auscultation; for that a stethoscope is one of the clinical tools used by physicians for diagnosis of lung disease and anomalies. On the other hand, recent technological advances have made telehealth systems a practical and effective option for health status assessment and remote patient monitoring. The interest in telehealth solutions have further grown with the COVID-19 pandemic. These telehealth systems aim to provide increased safety and help to cope with the massive growth in healthcare demand. Particularly, employing acoustic sensors to collect breathing sound would enable real-time assessment and instantaneous detection of anomalies. However, existing work focuses on autonomous determination of respiratory rate which is not suitable for anomaly detection due to inability to deal with noisy data recording. This paper presents a novel approach for effective breathing sound analysis. We promote a new segmentation mechanism of the captured acoustic signals to identify breathing cycles in recorded sound signals. A scoring scheme is applied to qualify the segment based on the targeted respiratory illness by the overall breathing sound analysis. We demonstrate the effectiveness of our approach via experiments using published COPD datasets.
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Affiliation(s)
- Wassila Lalouani
- Department of Computer and Information Science, Towson University, USA
| | - Mohamed Younis
- CSEE Dept., Univ. of Maryland, Baltimore County, Baltimore, MD, USA
| | | | - Lloyd E. Emokpae
- LASARRUS Clinic and Research Center Inc., Baltimore, MD, USA,Corresponding author
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18
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Zhang M, Sykes DL, Brindle K, Sadofsky LR, Morice AH. Chronic cough-the limitation and advances in assessment techniques. J Thorac Dis 2022; 14:5097-5119. [PMID: 36647459 PMCID: PMC9840016 DOI: 10.21037/jtd-22-874] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
Accurate and consistent assessments of cough are essential to advance the understanding of the mechanisms of cough and individualised the management of patients. Considerable progress has been made in this work. Here we reviewed the currently available tools for subjectively and objectively measuring both cough sensitivity and severity. We also provided some opinions on the new techniques and future directions. The simple and practical Visual Analogue Scale (VAS), the Leicester Cough Questionnaire (LCQ), and the Cough Specific Quality of Life Questionnaire (CQLQ) are the most widely used self-reported questionnaires for evaluating and quantifying cough severity. The Hull Airway Reflux Questionnaire (HARQ) is a tool to elucidate the constellation of symptoms underlying the diagnosis of chronic cough. Chemical excitation tests are widely used to explore the pathophysiological mechanisms of the cough reflex, such as capsaicin, citric acid and adenosine triphosphate (ATP) challenge test. Cough frequency is an ideal primary endpoint for clinical research, but the application of cough counters has been limited in clinical practice by the high cost and reliance on aural validation. The ongoing development of cough detection technology for smartphone apps and wearable devices will hopefully simplify cough counting, thus transitioning it from niche research to a widely available clinical application.
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Affiliation(s)
- Mengru Zhang
- Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, UK;,Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dominic L. Sykes
- Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, UK
| | - Kayleigh Brindle
- Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, UK
| | - Laura R. Sadofsky
- Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, UK
| | - Alyn H. Morice
- Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, UK
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19
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Zimmer AJ, Ugarte-Gil C, Pathri R, Dewan P, Jaganath D, Cattamanchi A, Pai M, Grandjean Lapierre S. Making cough count in tuberculosis care. COMMUNICATIONS MEDICINE 2022; 2:83. [PMID: 35814294 PMCID: PMC9258463 DOI: 10.1038/s43856-022-00149-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/21/2022] [Indexed: 11/28/2022] Open
Abstract
Cough assessment is central to the clinical management of respiratory diseases, including tuberculosis (TB), but strategies to objectively and unobtrusively measure cough are lacking. Acoustic epidemiology is an emerging field that uses technology to detect cough sounds and analyze cough patterns to improve health outcomes among people with respiratory conditions linked to cough. This field is increasingly exploring the potential of artificial intelligence (AI) for more advanced applications, such as analyzing cough sounds as a biomarker for disease screening. While much of the data are preliminary, objective cough assessment could potentially transform disease control programs, including TB, and support individual patient management. Here, we present an overview of recent advances in this field and describe how cough assessment, if validated, could support public health programs at various stages of the TB care cascade.
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Affiliation(s)
- Alexandra J. Zimmer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - César Ugarte-Gil
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Puneet Dewan
- Bill & Melinda Gates Foundation, Seattle, WA USA
| | - Devan Jaganath
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110 USA
- Center for Tuberculosis, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110 USA
| | - Adithya Cattamanchi
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110 USA
- Center for Tuberculosis, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110 USA
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Simon Grandjean Lapierre
- McGill International TB Centre, Montreal, Canada
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, 900 Rue Saint-Denis, Montréal, QC Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC Canada
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20
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Chung KF, McGarvey L, Song WJ, Chang AB, Lai K, Canning BJ, Birring SS, Smith JA, Mazzone SB. Cough hypersensitivity and chronic cough. Nat Rev Dis Primers 2022; 8:45. [PMID: 35773287 PMCID: PMC9244241 DOI: 10.1038/s41572-022-00370-w] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 12/13/2022]
Abstract
Chronic cough is globally prevalent across all age groups. This disorder is challenging to treat because many pulmonary and extrapulmonary conditions can present with chronic cough, and cough can also be present without any identifiable underlying cause or be refractory to therapies that improve associated conditions. Most patients with chronic cough have cough hypersensitivity, which is characterized by increased neural responsivity to a range of stimuli that affect the airways and lungs, and other tissues innervated by common nerve supplies. Cough hypersensitivity presents as excessive coughing often in response to relatively innocuous stimuli, causing significant psychophysical morbidity and affecting patients' quality of life. Understanding of the mechanisms that contribute to cough hypersensitivity and excessive coughing in different patient populations and across the lifespan is advancing and has contributed to the development of new therapies for chronic cough in adults. Owing to differences in the pathology, the organs involved and individual patient factors, treatment of chronic cough is progressing towards a personalized approach, and, in the future, novel ways to endotype patients with cough may prove valuable in management.
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Affiliation(s)
- Kian Fan Chung
- Experimental Studies Unit, National Heart & Lung Institute, Imperial College London, London, UK
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, London, UK
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland's University of Technology and Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Division of Child Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kefang Lai
- The First Affiliated Hospital of Guangzhou Medical University, National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | | | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Stuart B Mazzone
- Department of Anatomy and Physiology, University of Melbourne, Victoria, Australia.
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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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22
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Gabaldón-Figueira JC, Keen E, Rudd M, Orrilo V, Blavia I, Chaccour J, Galvosas M, Small P, Grandjean Lapierre S, Chaccour C. Longitudinal passive cough monitoring and its implications for detecting changes in clinical status. ERJ Open Res 2022; 8:00001-2022. [PMID: 35586452 PMCID: PMC9108969 DOI: 10.1183/23120541.00001-2022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/17/2022] [Indexed: 11/05/2022] Open
Abstract
Research question What is the impact of the duration of cough monitoring on its accuracy in detecting changes in the cough frequency? Materials and methods This is a statistical analysis of a prospective cohort study. Participants were recruited in the city of Pamplona (Northern Spain), and their cough frequency was passively monitored using smartphone-based acoustic artificial intelligence software. Differences in cough frequency were compared using a one-tailed Mann-Whitney U test and a randomisation routine to simulate 24-h monitoring. Results 616 participants were monitored for an aggregated duration of over 9 person-years and registered 62 325 coughs. This empiric analysis found that an individual's cough patterns are stochastic, following a binomial distribution. When compared to continuous monitoring, limiting observation to 24 h can lead to inaccurate estimates of change in cough frequency, particularly in persons with low or small changes in rate. Interpretation Detecting changes in an individual's rate of coughing is complicated by significant stochastic variability within and between days. Assessing change based solely on intermittent sampling, including 24-h, can be misleading. This is particularly problematic in detecting small changes in individuals who have a low rate and/or high variance in cough pattern.
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Affiliation(s)
| | - Eric Keen
- Research and Development Dept, Hyfe Inc, Wilmington, DE, USA
| | - Matthew Rudd
- Research and Development Dept, Hyfe Inc, Wilmington, DE, USA
- Dept of Mathematics and Computer Science, The University of the South, Sewanee, TN, USA
| | - Virginia Orrilo
- School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | - Isabel Blavia
- School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | - Juliane Chaccour
- Dept of Microbiology and Infectious Diseases, Clinica Universidad de Navarra, Pamplona, Spain
| | | | - Peter Small
- Research and Development Dept, Hyfe Inc, Wilmington, DE, USA
- Dept of Global Health, University of Washington, Seattle, WA, USA
| | - Simon Grandjean Lapierre
- Immunopathology Axis, Research Center of the University of Montreal Hospital Center, Montréal, QC, Canada
- Dept of Microbiology, Infectious Diseases and Immunology, Research Center of the University of Montreal Hospital Center, Montreal, QC, Canada
- These authors contributed equally
| | - Carlos Chaccour
- Dept of Microbiology and Infectious Diseases, Clinica Universidad de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
- These authors contributed equally
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Kruizinga MD, Zhuparris A, Dessing E, Krol FJ, Sprij AJ, Doll RJ, Stuurman FE, Exadaktylos V, Driessen GJA, Cohen AF. Development and technical validation of a smartphone-based pediatric cough detection algorithm. Pediatr Pulmonol 2022; 57:761-767. [PMID: 34964557 PMCID: PMC9306830 DOI: 10.1002/ppul.25801] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Coughing is a common symptom in pediatric lung disease and cough frequency has been shown to be correlated to disease activity in several conditions. Automated cough detection could provide a noninvasive digital biomarker for pediatric clinical trials or care. The aim of this study was to develop a smartphone-based algorithm that objectively and automatically counts cough sounds of children. METHODS The training set was composed of 3228 pediatric cough sounds and 480,780 noncough sounds from various publicly available sources and continuous sound recordings of 7 patients admitted due to respiratory disease. A Gradient Boost Classifier was fitted on the training data, which was subsequently validated on recordings from 14 additional patients aged 0-14 admitted to the pediatric ward due to respiratory disease. The robustness of the algorithm was investigated by repeatedly classifying a recording with the smartphone-based algorithm during various conditions. RESULTS The final algorithm obtained an accuracy of 99.7%, sensitivity of 47.6%, specificity of 99.96%, positive predictive value of 82.2% and negative predictive value 99.8% in the validation dataset. The correlation coefficient between manual- and automated cough counts in the validation dataset was 0.97 (p < .001). The intra- and interdevice reliability of the algorithm was adequate, and the algorithm performed best at an unobstructed distance of 0.5-1 m from the audio source. CONCLUSION This novel smartphone-based pediatric cough detection application can be used for longitudinal follow-up in clinical care or as digital endpoint in clinical trials.
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Affiliation(s)
- Matthijs D Kruizinga
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Eva Dessing
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Fas J Krol
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Arwen J Sprij
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | | | | | | | - Gertjan J A Driessen
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Department of pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
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24
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Keen EM, True EJ, Summers AR, Smith EC, Brew J, Grandjean Lapierre S. High-throughput digital cough recording on a university campus: A SARS-CoV-2-negative curated open database and operational template for acoustic screening of respiratory diseases. Digit Health 2022; 8:20552076221097513. [PMID: 35558638 PMCID: PMC9087241 DOI: 10.1177/20552076221097513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Respiratory illnesses have information-rich acoustic biomarkers, such as cough, that
can potentially play an important role in screening populations for disease risk. To
realize that potential, datasets of paired acoustic-clinical samples are needed for the
development and validation of acoustic screening models, and protocols for collecting
acoustic samples must be efficient and safe. We collected cough acoustic signatures at a
high-throughput SARS-CoV-2 testing site on a college campus. Here, we share logistical
details and the dataset of acoustic cough signatures paired with the gold standard in
SARS-CoV-2 testing of SARS-CoV-2 genomic sequences using qRT-PCR. Methods Cough recordings were collected in winter-spring 2021 at a rural residential college
(Sewanee, TN, USA), where approximately 2000 students were tested for SARS-CoV-2 on a
weekly basis. Cough collection was managed by student volunteers using custom
software. Results 4302 coughs were recorded from 960 participants over 11 weeks. All coughs were COVID-19
negative. Approximately 30 s were required to check-in a participant and collect their
cough. Conclusion The value of acoustic screening tools depends upon our ability to develop and implement
them reliably and quickly. For that to happen, high-quality datasets and logistical
insights must be collected and shared on an ongoing basis.
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Affiliation(s)
- Eric M. Keen
- Sewanee: The University of the South, Sewanee, TN, USA
- Hyfe, Inc., Wilmington, DE, USA
| | - Emily J. True
- Sewanee: The University of the South, Sewanee, TN, USA
| | | | | | | | - Simon Grandjean Lapierre
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montréal, Québec, Canada
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
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25
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Lee JWY, Tay TR, Borg BM, Sheriff N, Vertigan A, Abramson MJ, Hew M. Laryngeal hypersensitivity and abnormal cough response during mannitol bronchoprovocation challenge. Respirology 2021; 27:48-55. [PMID: 34617364 DOI: 10.1111/resp.14165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/13/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Inhalational challenge with dry mannitol powder may potentially induce cough by two mechanisms: airway bronchoconstriction or laryngeal irritation. This prospective observational study investigated laryngeal and bronchial components of cough induced by mannitol challenge. METHODS We recruited consecutive patients referred for clinical mannitol challenge. The Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) was administered. Throughout testing, coughs were audio-recorded to derive a cough frequency index per time and dose of mannitol. Relationships between cough indices, laryngeal hypersensitivity and bronchial hyperresponsiveness (BHR) were examined. Participants were classified by cough characteristics with k-means cluster analysis. RESULTS Of 90 patients who underwent challenge, 83 completed both the questionnaire and challenge. Cough frequency was greater in patients with abnormal laryngeal hypersensitivity (p = 0.042), but not in those with BHR. There was a moderate negative correlation between coughs per minute and laryngeal hypersensitivity score (r = -0.315, p = 0.004), with lower LHQ scores being abnormal. Cluster analysis identified an older, female-predominant cluster with higher cough frequency and laryngeal hypersensitivity, and a younger, gender-balanced cluster with lower cough frequency and normal laryngeal sensitivity. CONCLUSION Cough frequency during mannitol challenge in our cohort reflected laryngeal hypersensitivity rather than BHR. Laryngeal hypersensitivity was more often present among older female patients. With the incorporation of cough indices, mannitol challenge may be useful to test for laryngeal hypersensitivity as well as BHR.
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Affiliation(s)
- Joy Wei-Yan Lee
- Allergy, Asthma and Clinical Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Brigitte M Borg
- Allergy, Asthma and Clinical Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Neha Sheriff
- Allergy, Asthma and Clinical Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Anne Vertigan
- Speech Pathology Department, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Vertigan AE, Kapela SL, Birring SS, Gibson PG. Feasibility and clinical utility of ambulatory cough monitoring in an outpatient clinical setting: a real-world retrospective evaluation. ERJ Open Res 2021; 7:00319-2021. [PMID: 34616839 PMCID: PMC8488350 DOI: 10.1183/23120541.00319-2021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
RESEARCH QUESTION Objective quantification of cough is rarely utilised outside of research settings and the role of cough frequency monitoring in clinical practice has not been established. This study examined the clinical utility of cough frequency monitoring in an outpatient clinical setting. METHODS The study involved a retrospective review of cough monitor data. Participants included 174 patients referred for treatment of cough and upper airway symptoms (103 chronic cough; 50 inducible laryngeal obstruction; 21 severe asthma) and 15 controls. Measures, taken prior to treatment, included 24-h ambulatory cough frequency using the Leicester Cough Monitor, the Leicester Cough Questionnaire and Laryngeal Hypersensitivity Questionnaire. Post-treatment data were available for 50 participants. Feasibility and clinical utility were also reported. RESULTS Analysis time per recording was up to 10 min. 75% of participants could use the monitors correctly, and most (93%) recordings were interpretable. The geometric mean cough frequency in patients was 10.1±2.9 (mean±sd) compared to 2.4±2.0 for healthy controls (p=0.003). There was no significant difference in cough frequency between clinical groups (p=0.080). Cough frequency decreased significantly following treatment (p<0.001). There was a moderate correlation between cough frequency and both cough quality of life and laryngeal hypersensitivity. Cough frequency monitoring was responsive to therapy and able to discriminate differences in cough frequency between diseases. CONCLUSION While ambulatory cough frequency monitoring remains a research tool, it provides useful clinical data that can assist in patient management. Logistical issues may preclude use in some clinical settings, and additional time needs to be allocated to the process.
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Affiliation(s)
- Anne E. Vertigan
- Speech Pathology, John Hunter Hospital, New Lambton Heights, NSW, Australia
- Priority Centre for Healthy Lungs, The University of Newcastle Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Sarah L. Kapela
- Speech Pathology, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Surinder S. Birring
- Respiratory Medicine, King's College Hospital, London, UK
- Dept of Respiratory Sciences, King's College London, London, UK
| | - Peter G. Gibson
- Priority Centre for Healthy Lungs, The University of Newcastle Hunter Medical Research Institute, New Lambton, NSW, Australia
- Centre of Excellence in Severe Asthma, The University of Newcastle Faculty of Health and Medicine, Callaghan, NSW, Australia
- Dept of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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Gabaldon-Figueira JC, Brew J, Doré DH, Umashankar N, Chaccour J, Orrillo V, Tsang LY, Blavia I, Fernández-Montero A, Bartolomé J, Grandjean Lapierre S, Chaccour C. Digital acoustic surveillance for early detection of respiratory disease outbreaks in Spain: a protocol for an observational study. BMJ Open 2021; 11:e051278. [PMID: 34215614 PMCID: PMC8257291 DOI: 10.1136/bmjopen-2021-051278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Cough is a common symptom of COVID-19 and other respiratory illnesses. However, objectively measuring its frequency and evolution is hindered by the lack of reliable and scalable monitoring systems. This can be overcome by newly developed artificial intelligence models that exploit the portability of smartphones. In the context of the ongoing COVID-19 pandemic, cough detection for respiratory disease syndromic surveillance represents a simple means for early outbreak detection and disease surveillance. In this protocol, we evaluate the ability of population-based digital cough surveillance to predict the incidence of respiratory diseases at population level in Navarra, Spain, while assessing individual determinants of uptake of these platforms. METHODS AND ANALYSIS Participants in the Cendea de Cizur, Zizur Mayor or attending the local University of Navarra (Pamplona) will be invited to monitor their night-time cough using the smartphone app Hyfe Cough Tracker. Detected coughs will be aggregated in time and space. Incidence of COVID-19 and other diagnosed respiratory diseases within the participants cohort, and the study area and population will be collected from local health facilities and used to carry out an autoregressive moving average analysis on those independent time series. In a mixed-methods design, we will explore barriers and facilitators of continuous digital cough monitoring by evaluating participation patterns and sociodemographic characteristics. Participants will fill an acceptability questionnaire and a subgroup will participate in focus group discussions. ETHICS AND DISSEMINATION Ethics approval was obtained from the ethics committee of the Centre Hospitalier de l'Université de Montréal, Canada and the Medical Research Ethics Committee of Navarre, Spain. Preliminary findings will be shared with civil and health authorities and reported to individual participants. Results will be submitted for publication in peer-reviewed scientific journals and international conferences. TRIAL REGISTRATION NUMBER NCT04762693.
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Affiliation(s)
| | - Joe Brew
- Research and Development Department, Hyfe, Wilmington, Delaware, USA
| | - Dominique Hélène Doré
- Immunopathology Axis, Research Center of the University of Montreal Hospital Center, Montréal, Québec, Canada
| | - Nita Umashankar
- Fowler College of Business, San Diego State University, San Diego, California, USA
| | - Juliane Chaccour
- Infectious Diseases Area, University of Navarra Clinic, Pamplona, Spain
| | - Virginia Orrillo
- School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | - Lai Yu Tsang
- Global Health Institute, Stony Brook University, Stony Brook, New York, USA
| | - Isabel Blavia
- School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | | | - Javier Bartolomé
- Primary Healthcare, Navarre Health Service-Osasunbidea, Zizur Mayor, Spain
| | - Simon Grandjean Lapierre
- Immunopathology Axis, Research Center of the University of Montreal Hospital Center, Montréal, Québec, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Research Center of the University of Montreal Hospital Center, Montreal, Québec, Canada
| | - C Chaccour
- Infectious Diseases Area, University of Navarra Clinic, Pamplona, Spain
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Ifakara Institute of Health, Ifakara Institute of Health, Ifakara, Tanzania
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28
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Pekacka-Egli AM, Kazmierski R, Lutz D, Kulnik ST, Pekacka-Falkowska K, Maszczyk A, Windisch W, Boeselt T, Spielmanns M. Predictive Value of Cough Frequency in Addition to Aspiration Risk for Increased Risk of Pneumonia in Dysphagic Stroke Survivors: A Clinical Pilot Study. Brain Sci 2021; 11:brainsci11070847. [PMID: 34202226 PMCID: PMC8301865 DOI: 10.3390/brainsci11070847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Post-stroke dysphagia leads to increased risk of aspiration and subsequent higher risk of pneumonia. It is important to not only diagnose post-stroke dysphagia early but also to evaluate the protective mechanism that counteracts aspiration, i.e., primarily cough. The aim of this study was to investigate the predictive value of cough frequency in addition to aspiration risk for pneumonia outcome. METHODS This was a single-center prospective observational study. Patients with first-ever strokes underwent clinical swallowing evaluation, fibreoptic endoscopic evaluation of swallowing (FEES), and overnight cough recording using LEOSound® (Löwenstein Medical GmbH & Co. KG, Bad Ems, Germany ). Penetration-Aspiration Scale (PAS) ratings and cough frequency measurements were correlated with incidence of pneumonia at discharge. RESULTS 11 women (37%) and 19 men (63%), mean age 70.3 years (SD ± 10.6), with ischemic stroke and dysphagia were enrolled. Correlation analysis showed statistically significant relationships between pneumonia and PAS (r = 0.521; p < 0.05), hourly cough frequency (r = 0,441; p < 0.05), and categories of cough severity (r = 0.428 p < 0.05), respectively. Logistic regression showed significant predictive effects of PAS (b = 0.687; p = 0.014) and cough frequency (b = 0.239; p = 0.041) for pneumonia outcome. CONCLUSION Cough frequency in addition to aspiration risk was an independent predictor of pneumonia in dysphagic stroke survivors.
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Affiliation(s)
- Anna Maria Pekacka-Egli
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland;
- Correspondence: (A.M.P.-E.); (M.S.); Tel.: +41-(55)-2566970 (A.M.P.-E.)
| | - Radoslaw Kazmierski
- Department for Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, 61701 Poznan, Poland;
- Department of Neurology, University of Zielona Gora, 65046 Zielona Gora, Poland
| | - Dietmar Lutz
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland;
| | - Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London SW17 0RE, UK;
| | - Katarzyna Pekacka-Falkowska
- Department for History and Philosophy of Medicine, Poznan University of Medical Sciences, 61701 Poznan, Poland;
| | - Adam Maszczyk
- Department for Methodology, Statistics, and Informatics Systems, Institute of Sport Science, Academy of Physical Education in Katowice, 40065 Katowice, Poland;
| | - Wolfram Windisch
- Department for Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, 58455 Witten, Germany;
- Department of Pneumology, Cologne Merheim Hospital Kliniken der Stadt Koeln GmbH, 51109 Koeln, Germany
| | - Tobias Boeselt
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Phillips University Marburg, 35037 Marburg, Germany;
| | - Marc Spielmanns
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
- Department for Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, 58455 Witten, Germany;
- Correspondence: (A.M.P.-E.); (M.S.); Tel.: +41-(55)-2566970 (A.M.P.-E.)
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The hopes and hazards of using personal health technologies in the diagnosis and prognosis of infections. LANCET DIGITAL HEALTH 2021; 3:e455-e461. [PMID: 34020933 DOI: 10.1016/s2589-7500(21)00064-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/17/2021] [Accepted: 04/01/2021] [Indexed: 12/15/2022]
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