The combined impact of respiratory diseases such as COPD, asthma, chronic cough and pneumonia on individuals and healthcare systems is staggering. COPD alone has an influence more than 15 million people and almost costs the healthcare system $50 billion annually.
Effective daily maintenance therapy allows many people suffering from these chronic conditions to live healthy and productive lives, but exacerbations are inevitable and can be fatal if not recognized and treated promptly.
And even if not fatal, poor monitoring leads to more emergency room visits and hospital stays. For example, COPD results in: more than two million ER and hospital visits per yearwhich are costly both financially and in terms of quality of life.
Some healthcare IT experts believe that this is where remote patient monitoring and artificial intelligence can play a role. That RPM and AI can help reduce costs and increase quality of life. We interviewed Dr. Peter Small, chief medical officer at Hyfe AI, a provider of AI algorithms that enable remote patient monitoring technologies, including cough tracking, to talk about these issues.
Q. What are some of the challenges facing healthcare today in respiratory health where remote patient monitoring could be helpful?
A. Early recognition of exacerbations is complicated by the stochastic nature of the symptoms. An example? Cough – a protean manifestation of many of these diseases that waxes and wanes on good and bad days.
In addition, patients are refractory to cough changes and often cannot recognize worsening symptoms until they become severe and require an emergency room visit or more intensive therapy.
I see the greatest value of remote patient monitoring as the ability to passively, continuously, and unobtrusively monitor their symptoms so they can better manage their disease. This has been shown, for example Cough monitoring can detect COPD exacerbations more than three days in advance of when patients seek care – allowing early intervention to prevent that exacerbation.
Q. Explain what acoustic AI is and how it can be used in remote patient monitoring.
A. Major language models like ChatGPT have received a lot of attention lately. But the use of deep learning models in healthcare is not new. These models have a huge need for data and it is therefore not surprising that the first ‘language’ was data-rich images. Well-established tools exist to assist healthcare providers in interpreting images in the fields of dermatology, ophthalmology, and radiology.
The next frontier in healthcare AI is acoustic AI, which is simply the application of these computational methods to sound. When trained on sufficiently large and diverse collections of annotated sounds, these approaches can recognize and classify sounds such as a heart murmur, a wheeze, or a cough.
And when integrated into digital stethoscopes, they can improve doctors’ diagnostic capabilities. By tracking their frequency, they can help with medical management decisions. And ultimately, when incorporated into consumer products, they will enable patients to better understand and manage their chronic medical conditions.
Q. What are the expected patient outcomes with this type of RPM for people with everything from simple coughs to chronic diseases like asthma or COPD?
A. Coughing is one of the most common problems for which people seek medical attention. responsible for almost one in five reasons to visit a healthcare provider. Despite living in the age of “precision health,” coughs simply aren’t measured, dramatically complicating their diagnosis and treatment.
Most coughs are caused by transient, self-limiting illnesses, such as upper respiratory tract infections. However, for many people the cough lasts for months or years and can be extremely problematic. Especially since COVID, cough patients have been stigmatized and are often reluctant to go out in public, attend movies, engage in religious services, and other daily activities.
Chronic cough is associated with urinary incontinence, broken ribs and is associated with feelings of social isolation and depression.
Fortunately, there have been significant advances in cough science over the past decade. Today, chronic cough is considered not only a symptom of common conditions, such as reflux, asthma and post-nasal drip, but also a disease in itself caused by neural hypersensitivity.
Understanding the neural pathways of cough has led to a pharmaceutical race to develop effective antitussives. It is likely that the FDA will approve a new cough medicine by the end of this year – the first in more than 60 years.
Objective, passive, automated and privacy-preserving cough monitoring will be a game changer for patients with chronic cough.
It will allow them to better understand their disease and communicate its severity to their doctors. It will enable healthcare providers to make a better diagnosis, select effective therapies and monitor the course of treatment. And it will help healthcare systems intervene quickly and prevent costly and dangerous exacerbations.
Q: Looking ahead, what is the potential for RPM in respiratory health, and where do you see this space going?
A. We are in the midst of a revolution in medicine aimed at empowering patients to monitor their own health with devices such as home spirometers and blood pressure monitors. The ability to continuously monitor signals, such as blood glucose, is becoming the standard for quality care.
As someone with a chronic cough (I’ve been coughing 40 to 80 times a day for over thirty years), I’m particularly excited about how continuous cough monitoring can allow me to have more informed conversations with my doctor and feel that I have more control. – to actually have more control – over my health and healthcare.
As a tuberculosis expert who has spent about as many years helping cough patients get tested for tuberculosis, I’m excited about how better monitoring of coughs will help doctors and health care systems improve care for a dozen serious medical conditions.
I predict that within a few years, cough-related conditions will be controlled, such as hypertension. If you have the disease, you should have a device at home to measure it. FDA-approved cough monitoring devices will be commercially available and used routinely by people with cough-related conditions.
And soon after, cough monitoring will become a kind of pedometer that’s ubiquitous on consumer devices and that people only pay attention to when they care. I look forward to the day when counting coughs is as easy as counting steps and as important as continuous glucose monitoring.
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