Home Monitoring of Asthma Exacerbations in Children and Adults With Use of an AI-Aided Stethoscope

PURPOSE

The advent of new medical devices allows patients with asthma to self-monitor at home, providing a more complete picture of their disease than occasional in-person clinic visits. This raises a pertinent question: which devices and parameters perform best in exacerbation detection?

METHODS

A total of 149 patients with asthma (90 children, 59 adults) participated in a 6-month observational study. Participants (or parents) regularly (daily for the first 2 weeks and weekly for the next 5.5 months, with increased frequency during exacerbations) performed self-examinations using 3 devices: an artificial intelligence (AI)-aided home stethoscope (providing wheezes, rhonchi, and coarse and fine crackles intensity; respiratory and heart rate; and inspiration-to-expiration ratio), a peripheral capillary oxygen saturation (SpO2) meter, and a peak expiratory flow (PEF) meter and filled out a health state survey. The resulting 6,029 examinations were evaluated by physicians for the presence of exacerbations. For each registered parameter, a machine learning model was trained, and the area under the receiver operating characteristic curve (AUC) was calculated to assess its utility in exacerbation detection.

RESULTS

The best single-parameter discriminators of exacerbations were wheezes intensity for young children (AUC 84% [95% CI, 82%-85%]), rhonchi intensity for older children (AUC 81% [95% CI, 79%-84%]), and survey answers for adults (AUC 92% [95% CI, 89%-95%]). The greatest efficacy (in terms of AUC) was observed for a combination of several parameters.

CONCLUSIONS

The AI-aided home stethoscope provides reliable information on asthma exacerbations. The parameters provided are effective for children, especially those younger than 5 years of age. The introduction of this tool to the health care system might enhance asthma exacerbation detection substantially and make remote monitoring of patients easier.

Practical implementation of artificial intelligence algorithms in pulmonary auscultation examination

Lung auscultation is an important part of a physical examination. However, its biggest drawback is its subjectivity. The results depend on the experience and ability of the doctor to perceive and distinguish pathologies in sounds heard via a stethoscope. This paper investigates a new method of automatic sound analysis based on neural networks (NNs), which has been implemented in a system that uses an electronic stethoscope for capturing respiratory sounds. It allows the detection of auscultatory sounds in four classes: wheezes, rhonchi, and fine and coarse crackles. In the blind test, a group of 522 auscultatory sounds from 50 pediatric patients were presented, and the results provided by a group of doctors and an artificial intelligence (AI) algorithm developed by the authors were compared. The gathered data show that machine learning (ML)-based analysis is more efficient in detecting all four types of phenomena, which is reflected in high values of recall (also called as sensitivity) and F1-score.Conclusions: The obtained results suggest that the implementation of automatic sound analysis based on NNs can significantly improve the efficiency of this form of examination, leading to a minimization of the number of errors made in the interpretation of auscultation sounds. What is Known: • Auscultation performance of average physician is very low. AI solutions presented in scientific literature are based on small data bases with isolated pathological sounds (which are far from real recordings) and mainly on leave-one-out validation method thus they are not reliable. What is New: • AI learning process was based on thousands of signals from real patients and a reliable description of recordings was based on multiple validation by physicians and acoustician resulting in practical and statistical prove of AI high performance.