A smartphone-based algorithm comprising cough analysis and patient-reported symptoms identifies acute exacerbations of asthma: a prospective, double blind, diagnostic accuracy study.
Paul PorterJoanna M BrisbaneUdantha AbeyratneNatasha L BearScott ClaxtonPublished in: The Journal of asthma : official journal of the Association for the Care of Asthma (2022)
Objective: Early and accurate recognition of asthma exacerbations reduces the duration and risk of hospitalization. Current diagnostic methods depend upon patient recognition of symptoms, expert clinical examination, or measures of lung function. Here, we aimed to develop and test the accuracy of a smartphone-based diagnostic algorithm that analyses five cough events and five patient-reported features (age, fever, acute or productive cough and wheeze) to detect asthma exacerbations. Methods: We conducted a double-blind, prospective, diagnostic accuracy study comparing the algorithm with expert clinical opinion and formal lung function testing. Results: One hundred nineteen participants >12 years with a physician-diagnosed history of asthma were recruited from a hospital in Perth, Western Australia: 46 with clinically confirmed asthma exacerbations, 73 with controlled asthma. The groups were similar in median age (54yr versus 60yr, p =0.72) and sex (female 76% versus 70%, p =0.5). The algorithm's positive percent agreement (PPA) with the expert clinical diagnosis of asthma exacerbations was 89% [95% CI: 76%, 96%]. The negative percent agreement (NPA) was 84% [95% CI: 73%, 91%]. The algorithm's performance for asthma exacerbations diagnosis exceeded its performance as a detector of patient-reported wheeze (sensitivity, 63.7%). Patient-reported wheeze in isolation was an insensitive marker of asthma exacerbations (PPA=53.8%, NPA=49%). Conclusions: Our diagnostic algorithm accurately detected the presence of an asthma exacerbation as a point-of-care test without requiring clinical examination or lung function testing. This method could improve the accuracy of telehealth consultations and might be helpful in Asthma Action Plans and patient-initiated therapy.
Keyphrases
- chronic obstructive pulmonary disease
- lung function
- cystic fibrosis
- patient reported
- air pollution
- machine learning
- deep learning
- clinical trial
- randomized controlled trial
- emergency department
- liver failure
- magnetic resonance imaging
- stem cells
- intensive care unit
- dna methylation
- computed tomography
- double blind
- primary care
- physical activity
- sleep quality
- case report
- drug induced
- contrast enhanced
- clinical practice
- aortic dissection
- extracorporeal membrane oxygenation
- electronic health record