Measurement and analysis of breath sounds

Existing breath sound measurement systems and possible new methods have been critically investigated. The frequency response of each part of the measurement system has been studied. Emphasis has been placed on frequency response of acoustic sensors; especially, a method to study a diaphragm type air-coupler in contact use has been proposed. Two new methods of breath sounds measurement have been studied: laser Doppler vibrometer and mobile phones. It has been shown that these two methods can find applications in breath sounds measurement, however there are some restrictions. A reliable automatic wheeze detection algorithm based on auditory modelling has been developed. That is the human’s auditory system is modelled as a bank of band pass filters, in which the bandwidths are frequency dependent. Wheezes are treated as signals additive to normal breath sounds (masker). Thus wheeze is detectable when it is above the masking threshold. This new algorithm has been validated using simulated and real data. It is superior to previous algorithms, being more reliable to detect wheezes and less prone to mistakes. Simulation of cardiorespiratory sounds and wheeze audibility tests have been developed. Simulated breath sounds can be used as a training tool, as well as an evaluation method. These simulations have shown that, under certain circumstance, there are wheezes but they are inaudible. It is postulated that this could also happen in real measurements. It has been shown that simulated sounds with predefined characteristics can be used as an objective method to evaluate automatic algorithms. Finally, the efficiency and necessity of heart sounds reduction procedures has been investigated. Based on wavelet decomposition and selective synthesis, heart sounds can be reduced with a cost of unnatural breath sounds. Heart sound reduction is shown not to be necessary if a time-frequency representation is used, as heart sounds have a fixed pattern in the time-frequency plane

Multichannel analysis of normal and continuous adventitious respiratory sounds for the assessment of pulmonary function in respiratory diseases

Premi extraordinari doctorat UPC curs 2015-2016, àmbit d’Enginyeria IndustrialRespiratory sounds (RS) are produced by turbulent airflows through the airways and are inhomogeneously transmitted through different media to the chest surface, where they can be recorded in a non-invasive way. Due to their mechanical nature and airflow dependence, RS are affected by respiratory diseases that alter the mechanical properties of the respiratory system. Therefore, RS provide useful clinical information about the respiratory system structure and functioning. Recent advances in sensors and signal processing techniques have made RS analysis a more objective and sensitive tool for measuring pulmonary function. However, RS analysis is still rarely used in clinical practice. Lack of a standard methodology for recording and processing RS has led to several different approaches to RS analysis, with some methodological issues that could limit the potential of RS analysis in clinical practice (i.e., measurements with a low number of sensors, no controlled airflows, constant airflows, or forced expiratory manoeuvres, the lack of a co-analysis of different types of RS, or the use of inaccurate techniques for processing RS signals). In this thesis, we propose a novel integrated approach to RS analysis that includes a multichannel recording of RS using a maximum of five microphones placed over the trachea and the chest surface, which allows RS to be analysed at the most commonly reported lung regions, without requiring a large number of sensors. Our approach also includes a progressive respiratory manoeuvres with variable airflow, which allows RS to be analysed depending on airflow. Dual RS analyses of both normal RS and continuous adventitious sounds (CAS) are also proposed. Normal RS are analysed through the RS intensity–airflow curves, whereas CAS are analysed through a customised Hilbert spectrum (HS), adapted to RS signal characteristics. The proposed HS represents a step forward in the analysis of CAS. Using HS allows CAS to be fully characterised with regard to duration, mean frequency, and intensity. Further, the high temporal and frequency resolutions, and the high concentrations of energy of this improved version of HS, allow CAS to be more accurately characterised with our HS than by using spectrogram, which has been the most widely used technique for CAS analysis. Our approach to RS analysis was put into clinical practice by launching two studies in the Pulmonary Function Testing Laboratory of the Germans Trias i Pujol University Hospital for assessing pulmonary function in patients with unilateral phrenic paralysis (UPP), and bronchodilator response (BDR) in patients with asthma. RS and airflow signals were recorded in 10 patients with UPP, 50 patients with asthma, and 20 healthy participants. The analysis of RS intensity–airflow curves proved to be a successful method to detect UPP, since we found significant differences between these curves at the posterior base of the lungs in all patients whereas no differences were found in the healthy participants. To the best of our knowledge, this is the first study that uses a quantitative analysis of RS for assessing UPP. Regarding asthma, we found appreciable changes in the RS intensity–airflow curves and CAS features after bronchodilation in patients with negative BDR in spirometry. Therefore, we suggest that the combined analysis of RS intensity–airflow curves and CAS features—including number, duration, mean frequency, and intensity—seems to be a promising technique for assessing BDR and improving the stratification of BDR levels, particularly among patients with negative BDR in spirometry. The novel approach to RS analysis developed in this thesis provides a sensitive tool to obtain objective and complementary information about pulmonary function in a simple and non-invasive way. Together with spirometry, this approach to RS analysis could have a direct clinical application for improving the assessment of pulmonary function in patients with respiratory diseases.Los sonidos respiratorios (SR) se generan con el paso del flujo de aire a través de las vías respiratorias y se transmiten de forma no homogénea hasta la superficie torácica. Dada su naturaleza mecánica, los SR se ven afectados en gran medida por enfermedades que alteran las propiedades mecánicas del sistema respiratorio. Por lo tanto, los SR proporcionan información clínica relevante sobre la estructura y el funcionamiento del sistema respiratorio. La falta de una metodología estándar para el registro y procesado de los SR ha dado lugar a la aparición de diferentes estrategias de análisis de SR con ciertas limitaciones metodológicas que podrían haber restringido el potencial y el uso de esta técnica en la práctica clínica (medidas con pocos sensores, flujos no controlados o constantes y/o maniobras forzadas, análisis no combinado de distintos tipos de SR o uso de técnicas poco precisas para el procesado de los SR). En esta tesis proponemos un método innovador e integrado de análisis de SR que incluye el registro multicanal de SR mediante un máximo de cinco micrófonos colocados sobre la tráquea yla superficie torácica, los cuales permiten analizar los SR en las principales regiones pulmonares sin utilizar un número elevado de sensores . Nuestro método también incluye una maniobra respiratoria progresiva con flujo variable que permite analizar los SR en función del flujo respiratorio. También proponemos el análisis combinado de los SR normales y los sonidos adventicios continuos (SAC), mediante las curvas intensidad-flujo y un espectro de Hilbert (EH) adaptado a las características de los SR, respectivamente. El EH propuesto representa un avance importante en el análisis de los SAC, pues permite su completa caracterización en términos de duración, frecuencia media e intensidad. Además, la alta resolución temporal y frecuencial y la alta concentración de energía de esta versión mejorada del EH permiten caracterizar los SAC de forma más precisa que utilizando el espectrograma, el cual ha sido la técnica más utilizada para el análisis de SAC en estudios previos. Nuestro método de análisis de SR se trasladó a la práctica clínica a través de dos estudios que se iniciaron en el laboratorio de pruebas funcionales del hospital Germans Trias i Pujol, para la evaluación de la función pulmonar en pacientes con parálisis frénica unilateral (PFU) y la respuesta broncodilatadora (RBD) en pacientes con asma. Las señales de SR y flujo respiratorio se registraron en 10 pacientes con PFU, 50 pacientes con asma y 20 controles sanos. El análisis de las curvas intensidad-flujo resultó ser un método apropiado para detectar la PFU , pues encontramos diferencias significativas entre las curvas intensidad-flujo de las bases posteriores de los pulmones en todos los pacientes , mientras que en los controles sanos no encontramos diferencias significativas. Hasta donde sabemos, este es el primer estudio que utiliza el análisis cuantitativo de los SR para evaluar la PFU. En cuanto al asma, encontramos cambios relevantes en las curvas intensidad-flujo yen las características de los SAC tras la broncodilatación en pacientes con RBD negativa en la espirometría. Por lo tanto, sugerimos que el análisis combinado de las curvas intensidad-flujo y las características de los SAC, incluyendo número, duración, frecuencia media e intensidad, es una técnica prometedora para la evaluación de la RBD y la mejora en la estratificación de los distintos niveles de RBD, especialmente en pacientes con RBD negativa en la espirometría. El método innovador de análisis de SR que se propone en esta tesis proporciona una nueva herramienta con una alta sensibilidad para obtener información objetiva y complementaria sobre la función pulmonar de una forma sencilla y no invasiva. Junto con la espirometría, este método puede tener una aplicación clínica directa en la mejora de la evaluación de la función pulmonar en pacientes con enfermedades respiratoriasAward-winningPostprint (published version

Identification Of Asthma Severity Levels Through Wheeze Sound Characterization And Classification Using Integrated Power Features

This study aimed to investigate and classify wheeze sound characteristics according to asthma severity levels (mild, moderate and severe) using integrated power (IP) features. Method: Validated and segmented wheeze sounds were obtained from the lower lung base (LLB) and trachea recordings of 55 asthmatic patients with different severity levels during tidal breathing manoeuvres. From the segments, nine datasets were obtained based on the auscultation location, breath phases and their combination. In this study, IP features were extracted for assessing asthma severity. Subsequently, univariate and multivariate (MANOVA) statistical analyses were separately implemented to analyse behaviour of wheeze sounds according to severity levels. Furthermore, the ensemble (ENS), knearest- neighbour (KNN) and support vector machine (SVM) classifiers were applied to classify the asthma severity levels. Results and conclusion: The univariate results of this study indicated that the majority of features significantly discriminated (p < 0.05) the severity levels in all the datasets. The MANOVA results yielded significantly (p < 0.05) large effect size in all datasets (including LLB-related) and almost all post hoc results were significant(p < 0.05). A comparison ofthe performance of classifiers revealed that eight ofthe nine datasets showed improved performance with the ENS classifier. The Trachea inspiratory (T-Inspir) dataset produced the highest performance. The overall best positive predictive rate (PPR) for the mild, moderate and severe severity levels were 100% (KNN), 92% (SVM) and 94% (ENS) respectively. Analysis related to auscultation locations revealed that tracheal wheeze sounds are more specific and sensitive predictors of asthma severity. Additionally, phase related investigations indicated that expiratory and inspiratory wheeze sounds are equally informative for the classification of asthma severit

Respiration-Based COPD Detection Using UWB Radar Incorporation with Machine Learning

COPD is a progressive disease that may lead to death if not diagnosed and treated at an early stage. The examination of vital signs such as respiration rate is a promising approach for the detection of COPD. However, simultaneous consideration of the demographic and medical characteristics of patients is very important for better results. The objective of this research is to investigate the capability of UWB radar as a non-invasive approach to discriminate COPD patients from healthy subjects. The non-invasive approach is beneficial in pandemics such as the ongoing COVID-19 pandemic, where a safe distance between people needs to be maintained. The raw data are collected in a real environment (a hospital) non-invasively from a distance of 1.5 m. Respiration data are then extracted from the collected raw data using signal processing techniques. It was observed that the respiration rate of COPD patients alone is not enough for COPD patient detection. However, incorporating additional features such as age, gender, and smoking history with the respiration rate lead to robust performance. Different machine-learning classifiers, including Naïve Bayes, support vector machine, random forest, k nearest neighbor (KNN), Adaboost, and two deep-learning models—a convolutional neural network and a long short-term memory (LSTM) network—were utilized for COPD detection. Experimental results indicate that LSTM outperforms all employed models and obtained 93% accuracy. Performance comparison with existing studies corroborates the superior performance of the proposed approach

Acoustical and flow characteristics of a cough as an index of pulmonary function in the guinea pig

Human studies indicate that cough sound and flow analysis may be useful for diagnosing pulmonary abnormalities. The purpose of this study was to evaluate an animal model for cough sound and flow analysis. A system was designed to expose guinea pigs to aerosols of citric acid (0.39M) and record resulting coughs at different stages of chemically induced specific airway resistance (sRAW). Coughs were divided into three categories (low sRAW, n = 113; moderate sRAW, n = 143; high sR AW, n = 93). 124 cough sound parameters were derived from the analysis of the sound pressure waves recorded during the cough. A principal component analysis was performed on the acquired data, and the resulting parameters were used to train a single neuron feed-forward back propagation neural network. The classification system was able to correctly discriminate between members of the high and low airway constriction groups with an accuracy of 0.946 and a sensitivity and specificity of 0.893

Contact and remote breathing rate monitoring techniques: a review

ABSTRACT: Breathing rate monitoring is a must for hospitalized patients with the current coronavirus disease 2019 (COVID-19). We review in this paper recent implementations of breathing monitoring techniques, where both contact and remote approaches are presented. It is known that with non-contact monitoring, the patient is not tied to an instrument, which improves patients’ comfort and enhances the accuracy of extracted breathing activity, since the distress generated by a contact device is avoided. Remote breathing monitoring allows screening people infected with COVID-19 by detecting abnormal respiratory patterns. However, non-contact methods show some disadvantages such as the higher set-up complexity compared to contact ones. On the other hand, many reported contact methods are mainly implemented using discrete components. While, numerous integrated solutions have been reported for non-contact techniques, such as continuous wave (CW) Doppler radar and ultrawideband (UWB) pulsed radar. These radar chips are discussed and their measured performances are summarized and compared

Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

Emergent measures and patterns of recovery during acute exacerbations of Chronic Obstructive Pulmonary Disease.

As exacerbações agudas da doença pulmonar obstrutiva crónica (EADPOC) são eventos frequentes e onerosos. Contudo, o conhecimento acerca da sua avaliação e curso de evolução é limitado. Este trabalho de investigação teve como objetivo compreender a avaliação e os padrões de recuperação das EADPOC geridas em contexto de ambulatório. Especificamente, pretendeu-se: i) aprofundar oconhecimento acerca das medidas de avaliação mais utilizadas na avaliação dedoentes com EADPOC e ii) explorar os padrões de recuperação durante as EADPOC utilizando diferentes medidas de avaliação. Foram realizados seis estudos. A Revisão Sistemática e os Estudos empíricos I e II responderam ao primeiro objetivo específico deste trabalho de investigação, sintetizando e explorando a fiabilidade, validade, capacidade de resposta e interpretabilidade de medidas de avaliação comummente utilizadas e de fácil acesso para a avaliação de doentes com EADPOC em contexto de ambulatório. Os resultados revelaram que apesar de existirem poucas medidas de avaliação com as suas propriedades métricas adequadamente estudadas, os seus valores de interpretabilidade parecem semelhantes aos estabelecidos em fases estáveis da DPOC. O segundo objetivo específico deste trabalho de investigação foi alcançado através de três Estudos empíricos (Estudos III, IV e V) que demonstraram que a recuperação de uma EADPOC é influenciada pelas características dos doentes no momento inicial da exacerbação. Estes Estudos mostraram ainda que as medidas reportadas pelos doentes e as medidas clínicas diferem nos seus padrões e tempos de recuperação durante as EADPOC. Os resultados deste trabalho de investigação constituem nova evidência acerca das medidas de avaliação e dos momentos mais adequados para avaliar, monitorizar e interpretar alterações no curso de EADPOC. É necessário realizar mais investigação com metodologias padrão, amostras maiores e desenhos de estudo longitudinais com avaliações pré e pós exacerbação de forma a consolidar estes resultados preliminares e aumentar o conhecimento acerca do curso de evolução das EADPOC geridas em contexto de ambulatório.Palavras-chave: DPOC, EXACERBAÇÕES, MEDIDAS DE RESULTADOS, PROPRIEDADES DE MEDIDA, RECUPERAÇÃO, EVOLUÇÃO.Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are frequent and burdensome events. However, knowledge about their assessment and course of evolution is limited. This research work focused on understanding the assessment and recovery pattern of AECOPD managed on an outpatient setting. Specifically, it aimed to: i) gain more insight on the outcome measures most used to assess patients with AECOPD and their measurement properties and ii) explore patterns of recovery of different outcomes and outcome measures during these events. Six studies were conducted. The Systematic Review and empirical Studies I and II addressed the first specific aim of this research work by synthetising and exploring the reliability, validity, responsiveness and interpretability of outcome measures commonly used and easily available to assess outpatients with AECOPD. Findings showed that although few outcome measures exist which measurement properties have been properly studied in patients with AECOPD, their interpretability values seem to be similar to those in stable patients. The second specific aim of this research work was addressed with three empirical Studies (Studies III, IV and V) which showed that the recovery from AECOPD is influenced by patients' characteristics assessed at the onset of the exacerbation. These Studies further evidenced different patterns and timings of recovery among patient-reported and clinical outcome measures. The findings of this research work constitute new evidence on the most adequate outcome measures and timings to assess, monitor and interpret changes during the course of AECOPD managed on an outpatient setting. Further research with standardised methodologies, larger samples and longitudinal pre-/post exacerbation designs is warranted to consolidate these preliminary findings and increase the scope of knowledge on the time course of AECOPD treated on an outpatient basis

New Models for Expert System Design

This thesis presents new work on the analysis of human lung sound. Experimental studies investigated the relationship between the condition of the lungs and the power spectrum of lung sound detected at the chest wall. The conclusion drawn from two clinical studies was that the median frequency of the lung sound power spectrum increases with a decrease in airway calibre. The technique for the analysis of lung sound presented in this thesis is a non-invasive method which may be capable of assessing differences in airway calibre between different lobes of the lung. An expert system for the analysis of lung sound data and pulmonary function data was designed. The expert knowledge was expressed in a belief logic, a system of logic which is more expressive than first order logic. New automated theorem proving methods were developed for the belief logic. The new methods were implemented to form the 'inference engine' of the expert system. The new expert system compared favourably with systems which perform a similar task. The use of belief logic allows introspective reasoning to be carried out. Plausible reasoning, a type of introspective reasoning which allows conclusions to be drawn when the database is incomplete, was proposed and tested. The author concludes that the use of a belief logic in expert system design has significant advantages over conventional approaches. The experimental results of the lung sound research were incorporated into the expert system rule base: the medical and expert system research were complementary

Some new techniques for pattern recognition research and lung sound signal analysis

This thesis describes the results of a collaborative research programme between the Department of Electronics & Electrical Engineering, University of Glasgow, and the Centre for Respiratory Investigation, Glasgow Royal Infirmary. The research was initially aimed at studying lung sound using signal processing and pattern recognition techniques. The use of pattern recogntion techniques was largely confined to exploratory data analysis which led to an interest in the methods themselves. A study was carried out to apply recent research in computational geometry to clustering Two geometric structures, the Gabriel graph and the relative neighbourhood graph, are both defined by a region of influence. A generalization of these graphs is used to find the conditions under which graphs defined by a region of influence are connected and planar. The Gabriel graph may be considered to be just planar and the relative neighbourhood graph to be just connected. From this two variable regions of influence were defined that were aimed at producing disconnected graphs and hence a partitioning of the data set, A hierarchic clustering based on relative distance may be generated by varying the size of the region of influence. The value of the clustering method is examined in terms of admissibility criteria and by a case study. An interactive display to complement the graph theoretical clustering was also developed. This display allows a partition in the clustering to be examined. The relationship between clusters in the partition may be studied by using the partition to define a contracted graph which is then displayed. Subgraphs of the original graph may be used to provide displays of individual clusterso This display should provide additional information about a partition and hence allow the user to understand the data better. The remainder of the work in this thesis concerns the application of pattern recogntition techniques to the analysis of lung sound signals. Breath sound was analysed using frequency domain methods since it is basically a continuous signal. Initially, a rather ad hoc method was used for feature extraction which was based on a piecewise constant approximation to the amplitude spectrum. While this method provided a useful set of features, it is clear that more systematic methods are required. These methods were used to study lung sound in four groups of patients: (1) normal patients, (2) patients with asbestosis, (3) patients with cryptogenic fibrosing alveolitis (CFA) and (4) patients with interstitial pulmonary oedema. The data sets were analysed using principal components analysis and the new graph theroretical clustering method (this data was used as a case study for the clustering method). Three groups of patients could be identified from the data;- (a) normal subjects, (b) patients with fibrosis of the lungs (asbestosis & CFA) and (c) patients with pulmonary oedema. These results suggest that lung sound may be able to make a useful contribution to non-invasive diagnosis. However more extensive studies are required before the real value of lung sound in diagnosis is established