Q&A: Monitoring pulmonary diseases, lung function at home via smartphone

Key takeaways:

• A smartphone-based tool that employs acoustic sensing and machine learning techniques is set to undergo testing.
• This tool is expected to be particularly beneficial for low-income patients.

Patients with COPD, asthma and cystic fibrosis may soon be able to monitor their diseases by using/breathing through a tool that connects to their smartphone, according to a University of Pittsburgh press release.

Acoustic WAveform Respiratory Evaluation (AWARE) is a smartphone-based tool that employs acoustic sensing and machine learning techniques to assess the condition of pulmonary diseases and measure lung function, the release outlined.

The tool is made up of three main pieces in addition to the smartphone, its speaker and its microphone: an adaptor, a connecting tube and a 3D-printed plastic mouthpiece.

With support from an NIH/National Heart Lung and Blood Institute (NHLBI) grant, recruitment for research testing the tool in both children and adults is underway.

Leaders behind this research include Wei Gao, PhD, associate professor of electrical and computer engineering at the University of Pittsburgh Swanson School of Engineering, Erick Forno, MD, MPH, professor of pediatrics at the Indiana University School of Medicine, and Wei Chen, PhD, professor of pediatrics, biostatistics and human genetics at University of Pittsburgh School of Public Health, according to the release.

Healio spoke with Gao and Forno to learn more about how AWARE works, the benefits this type of technology brings for patients and clinicians, as well as the aims for studies assessing the tool.

Healio: What was the inspiration behind wanting to develop a pulmonary telemedicine tool?

Gao and Forno: There is a dire need for innovative, accessible ways to evaluate and monitor respiratory health.

Patient (or parent) report of subjective symptoms is very important, but some patients don’t notice changes in their lung function, or they may be chronically sick and think their low lung function is “normal.” Lung function testing usually happens only at specialized centers, and often only one to two times a year; most of these tests require either expensive equipment or difficult forceful maneuvers that may be difficult for some young or sick patients.

We wanted to leverage our joint clinical and bioengineering expertise to solve all these issues, so we could objectively monitor lung function at home, leveraging smartphones that most families in the U.S. already own.

We have developed the current version of AWARE with funding from the University of Pittsburgh and the National Science Foundation (NSF). Now this grant from NIH/NHLBI will allow us to test AWARE in a large number of individuals, a broad age range and several different airway diseases such as asthma, COPD, cystic fibrosis and others.

Healio: What is AWARE? How does it work?

Gao and Forno: AWARE is a pulmonary telemedicine solution that allows turning an off-the-shelf smartphone into a fully functional pulmonary examination device, which can probe the subject’s airway and evaluate the condition of pulmonary diseases, including asthma, COPD and cystic fibrosis, from the knowledge about the airway’s shape and physiological characteristics.

The basic technique in AWARE is acoustic sensing, which is similar to how the sonar system works: acoustic signals are generated by the smartphone’s bottom speaker, directed into the subject’s airway via the adaptor, tube and mouthpiece attached to the bottom of the smartphone, and then reflected by the airway lumen. The reflected acoustic signals are then received by the smartphone’s bottom microphone, and we use signal processing algorithms and machine learning models on the smartphone to analyze the airway conditions by analyzing the difference between transmitted and received acoustic signals.

Healio: How will this smartphone-based technology benefit both patients and clinicians?

Gao and Forno: The pandemic happened shortly after we had started working on AWARE, and it dramatically highlighted the need. Patients were unable to access lung function testing, physicians had to rely on families reporting symptoms and people were getting sick without a way to evaluate them. Most households in the country already own a smartphone, so if AWARE had been in place, doctors would have had a way to objectively evaluate their patients with a tool most people in the U.S. can easily access.

AWARE could also be a very valuable resource for groups with low incomes or socioeconomic status, which may have limited access to in-hospital medical care. In our past clinical study, AWARE has helped many low-income families, especially during the COVID-19 pandemic when Medicare resources were scarce and less accessible.

Healio: You briefly mention in the release that there are already devices that continuously monitor pulmonary diseases/conditions remotely. How is your smartphone-based technology going to be different from these devices? How does it address the weaknesses of existing devices?

Gao and Forno: Portable spirometers exist at different price ranges, but most often cost several hundred dollars. AWARE would work with smartphones that people already own, plus a very inexpensive plastic adaptor. Spirometry requires forced breathing maneuvers that can be difficult to do for children or some people with severe lung diseases; AWARE does not require forceful maneuvers. While no device could monitor the airways “continuously” as in 24/7, a solution such as AWARE that is inexpensive, readily accessible and easy to use would facilitate more frequent and consistent testing for patients and objective clinical information for doctors.

Healio: You presented a poster at the 2023 American Thoracic Society International Conference on AWARE. What were the main takeaways from this assessment?

Gao and Forno: AWARE was incredibly well received. Attendees, both pulmonary clinicians and researchers, were extremely interested in having a solution like AWARE available for their patients.

We also asked participants from our AWARE pilot studies, and the great majority thought it would be a good solution for them, they would likely use AWARE frequently and they would like their doctors to have access to AWARE data.

Healio: How will you be evaluating AWARE moving forward? What are your primary and secondary outcomes?

Gao and Forno: The current grant from the NIH/NHLBI will allow us to recruit over 700 children and adults, both healthy and with various airway conditions including asthma, COPD and cystic fibrosis.

We will evaluate three main aims over the course of the next 5 years: 1) How accurate AWARE is in differentiating healthy from unhealthy airways and among the different diseases; 2) How closely AWARE can estimate traditional indices of lung function used in referral centers; and 3) If AWARE can detect lung disease exacerbations early on, to prompt patients to talk to their doctors or seek care.

We will also be evaluating whether AWARE measurements correlate with disease severity and the symptoms patients experience.

AWARE exemplifies the great promise of cross-disciplinary collaboration between engineering and clinical research. We are very excited about this research direction that would bring significant societal impact.

Healio: When can clinicians expect to see and recommend this product to their patients?

Gao and Forno: How quickly AWARE can become available for broad use will depend on how smoothly recruitment goes for the study and the quality of the results we get from the testing.

References:

• A breath of fresh air for pulmonary telemedicine. https://news.engineering.pitt.edu/a-breath-of-fresh-air-for-pulmonary-telemedicine/. Published Aug. 15, 2024. Accessed Aug. 20, 2024.
• Yin X, et al. Am J Respir Crit Care Med. 2023;doi:10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A1875.