{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T20:27:38Z","timestamp":1780604858045,"version":"3.54.1"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T00:00:00Z","timestamp":1625184000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T00:00:00Z","timestamp":1625184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are commonly encountered in the primary care setting, though the accurate and timely diagnosis is problematic. Using technology like that employed in speech recognition technology, we developed a smartphone-based algorithm for rapid and accurate diagnosis of AECOPD. The algorithm incorporates patient-reported features (age, fever, and new cough), audio data from five coughs and can be deployed by novice users. We compared the accuracy of the algorithm to expert clinical assessment. In patients with known COPD, the algorithm correctly identified the presence of AECOPD in 82.6% (95% CI: 72.9\u201389.9%) of subjects (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200986). The absence of AECOPD was correctly identified in 91.0% (95% CI: 82.4\u201396.3%) of individuals (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200978). The diagnostic agreement was maintained in milder cases of AECOPD (PPA: 79.2%, 95% CI: 68.0\u201387.8%), who typically comprise the cohort presenting to primary care. The algorithm may aid early identification of AECOPD and be incorporated in patient self-management plans.\n                  <\/jats:p>","DOI":"10.1038\/s41746-021-00472-x","type":"journal-article","created":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T06:21:22Z","timestamp":1625206882000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Identifying acute exacerbations of chronic obstructive pulmonary disease using patient-reported symptoms and cough feature analysis"],"prefix":"10.1038","volume":"4","author":[{"given":"Scott","family":"Claxton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9051-589X","authenticated-orcid":false,"given":"Paul","family":"Porter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3364-5414","authenticated-orcid":false,"given":"Joanna","family":"Brisbane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Bear","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javan","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vesa","family":"Peltonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Della","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udantha","family":"Abeyratne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,2]]},"reference":[{"key":"472_CR1","doi-asserted-by":"publisher","first-page":"020415","DOI":"10.7189\/jogh.05.020415","volume":"5","author":"D Adeloye","year":"2015","unstructured":"Adeloye, D. et al. Global and regional estimates of COPD prevalence: systematic review and meta-analysis. J. Glob. Health 5, 020415 (2015).","journal-title":"J. Glob. Health"},{"key":"472_CR2","unstructured":"Global Initiative for Chronic Obstructive Pulmonary Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2020 Report), www.goldcopd.org (2020)."},{"key":"472_CR3","doi-asserted-by":"publisher","first-page":"65","DOI":"10.2147\/COPD.S54417","volume":"9","author":"YS Punekar","year":"2014","unstructured":"Punekar, Y. S., Shukla, A. & Mullerova, H. COPD management costs according to the frequency of COPD exacerbations in UK primary care. Int. J. Chron. Obstruct. Pulmon. Dis. 9, 65\u201373 (2014).","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"472_CR4","doi-asserted-by":"publisher","first-page":"757","DOI":"10.2147\/COPD.S36997","volume":"7","author":"MK Pasquale","year":"2012","unstructured":"Pasquale, M. K., Sun, S. X., Song, F., Hartnett, H. J. & Stemkowski, S. A. Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population. Int. J. Chron. Obstruct. Pulmon. Dis. 7, 757\u2013764 (2012).","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"472_CR5","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1164\/rccm.200310-1443OC","volume":"169","author":"TM Wilkinson","year":"2004","unstructured":"Wilkinson, T. M., Donaldson, G. C., Hurst, J. R., Seemungal, T. A. & Wedzicha, J. A. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 169, 1298\u20131303 (2004).","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"472_CR6","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1080\/15412550902751746","volume":"6","author":"D Chandra","year":"2009","unstructured":"Chandra, D., Tsai, C. L. & Camargo, C. A. Jr. Acute exacerbations of COPD: delay in presentation and the risk of hospitalization. COPD 6, 95\u2013103 (2009).","journal-title":"COPD"},{"key":"472_CR7","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1136\/thx.2009.127621","volume":"66","author":"EW Bischoff","year":"2011","unstructured":"Bischoff, E. W. et al. Effects of written action plan adherence on COPD exacerbation recovery. Thorax 66, 26\u201331 (2011).","journal-title":"Thorax"},{"key":"472_CR8","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1186\/s12931-019-1046-6","volume":"20","author":"P Porter","year":"2019","unstructured":"Porter, P. et al. A prospective multicentre study testing the diagnostic accuracy of an automated cough sound centred analytic system for the identification of common respiratory disorders in children. Respir. Res. 20, 81 (2019).","journal-title":"Respir. Res."},{"key":"472_CR9","doi-asserted-by":"publisher","first-page":"e24587","DOI":"10.2196\/24587","volume":"4","author":"P Porter","year":"2020","unstructured":"Porter, P. et al. Diagnosing Chronic Obstructive Airway Disease on a smartphone using patient-reported symptoms and cough analysis: diagnostic accuracy study. JMIR Formative Res. 4, e24587 (2020).","journal-title":"JMIR Formative Res."},{"key":"472_CR10","doi-asserted-by":"publisher","unstructured":"Porter, P. et al. Diagnosing community-acquired pneumonia: diagnostic accuracy study of a cough-centred algorithm for use in primary care and acute-care consultations. Br. J. Gen. Pract. https:\/\/doi.org\/10.3399\/BJGP.2020.0750 (2020).","DOI":"10.3399\/BJGP.2020.0750"},{"key":"472_CR11","doi-asserted-by":"publisher","first-page":"2448","DOI":"10.1007\/s10439-013-0836-0","volume":"41","author":"UR Abeyratne","year":"2013","unstructured":"Abeyratne, U. R., Swarnkar, V., Setyati, A. & Triasih, R. Cough sound analysis can rapidly diagnose childhood pneumonia. Ann. Biomed. Eng. 41, 2448\u20132462 (2013).","journal-title":"Ann. Biomed. Eng."},{"key":"472_CR12","doi-asserted-by":"publisher","first-page":"095001","DOI":"10.1088\/1361-6579\/aad948","volume":"39","author":"RV Sharan","year":"2018","unstructured":"Sharan, R. V. et al. Predicting spirometry readings using cough sound features and regression. Physiol. Meas. 39, 095001 (2018).","journal-title":"Physiol. Meas."},{"key":"472_CR13","first-page":"4578","volume":"2017","author":"RV Sharan","year":"2017","unstructured":"Sharan, R. V., Abeyratne, U. R., Swarnkar, V. R. & Porter, P. Cough sound analysis for diagnosing croup in pediatric patients using biologically inspired features. Annu. Int. Conf. IEEE Eng. Med. Biol. Soc. 2017, 4578\u20134581 (2017).","journal-title":"Annu. Int. Conf. IEEE Eng. Med. Biol. Soc."},{"key":"472_CR14","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1109\/TBME.2018.2849502","volume":"66","author":"RV Sharan","year":"2019","unstructured":"Sharan, R. V., Abeyratne, U. R., Swarnkar, V. R. & Porter, P. Automatic croup diagnosis using cough sound recognition. IEEE Trans. Biomed. Eng. 66, 485\u2013495 (2019).","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"472_CR15","doi-asserted-by":"publisher","unstructured":"Swarnkar, V. et al. Stratifying asthma severity in children using cough sound analytic technology. J. Asthma https:\/\/doi.org\/10.1080\/02770903.2019.1684516 (2019).","DOI":"10.1080\/02770903.2019.1684516"},{"key":"472_CR16","first-page":"1764","volume":"2013","author":"V Swarnkar","year":"2013","unstructured":"Swarnkar, V. et al. Neural network based algorithm for automatic identification of cough sounds. Annu. Int. Conf. IEEE Eng. Med. Biol. Soc. 2013, 1764\u20131767 (2013).","journal-title":"Annu. Int. Conf. IEEE Eng. Med. Biol. Soc."},{"key":"472_CR17","doi-asserted-by":"publisher","first-page":"1396","DOI":"10.1016\/j.rmed.2011.05.007","volume":"105","author":"A Gurung","year":"2011","unstructured":"Gurung, A., Scrafford, C. G., Tielsch, J. M., Levine, O. S. & Checkley, W. Computerized lung sound analysis as diagnostic aid for the detection of abnormal lung sounds: a systematic review and meta-analysis. Respir. Med. 105, 1396\u20131403 (2011).","journal-title":"Respir. Med."},{"key":"472_CR18","first-page":"161","volume":"173","author":"A Hashemi","year":"2012","unstructured":"Hashemi, A., Arabalibeik, H. & Agin, K. Classification of wheeze sounds using cepstral analysis and neural networks. Stud. Health Technol. Inf. 173, 161\u2013165 (2012).","journal-title":"Stud. Health Technol. Inf."},{"key":"472_CR19","doi-asserted-by":"publisher","first-page":"e111","DOI":"10.1136\/amiajnl-2012-001171","volume":"20","author":"DS Morillo","year":"2013","unstructured":"Morillo, D. S., Leon Jimenez, A. & Moreno, S. A. Computer-aided diagnosis of pneumonia in patients with chronic obstructive pulmonary disease. J. Am. Med. Inf. Assoc. 20, e111\u2013e117 (2013).","journal-title":"J. Am. Med. Inf. Assoc."},{"key":"472_CR20","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1007\/s11517-012-0903-y","volume":"50","author":"S Xie","year":"2012","unstructured":"Xie, S., Jin, F., Krishnan, S. & Sattar, F. Signal feature extraction by multi-scale PCA and its application to respiratory sound classification. Med. Biol. Eng. Comput. 50, 759\u2013768 (2012).","journal-title":"Med. Biol. Eng. Comput."},{"key":"472_CR21","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1111\/j.1440-1843.2011.01926.x","volume":"16","author":"L Edwards","year":"2011","unstructured":"Edwards, L. et al. The value of the CRB65 score to predict mortality in exacerbations of COPD requiring hospital admission. Respirology 16, 625\u2013629 (2011).","journal-title":"Respirology"},{"key":"472_CR22","doi-asserted-by":"publisher","unstructured":"Lenferink, A. et al. Self\u2010management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Cochrane Database of Syst. Rev. https:\/\/doi.org\/10.1002\/14651858.CD011682.pub2 (2017).","DOI":"10.1002\/14651858.CD011682.pub2"},{"key":"472_CR23","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1378\/chest.130.1.133","volume":"130","author":"R Kessler","year":"2006","unstructured":"Kessler, R. et al. Patient understanding, detection, and experience of COPD exacerbations: an observational, interview-based study. Chest 130, 133\u2013142 (2006).","journal-title":"Chest"},{"key":"472_CR24","doi-asserted-by":"publisher","first-page":"14062","DOI":"10.1038\/npjpcrm.2014.62","volume":"24","author":"V Williams","year":"2014","unstructured":"Williams, V., Hardinge, M., Ryan, S. & Farmer, A. Patients\u2019 experience of identifying and managing exacerbations in COPD: a qualitative study. NPJ Prim. Care Respir. Med. 24, 14062 (2014).","journal-title":"NPJ Prim. Care Respir. Med."},{"key":"472_CR25","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1164\/rccm.200708-1290OC","volume":"177","author":"L Langsetmo","year":"2008","unstructured":"Langsetmo, L., Platt, R. W., Ernst, P. & Bourbeau, J. Underreporting exacerbation of chronic obstructive pulmonary disease in a longitudinal cohort. Am. J. Respir. Crit. Care Med. 177, 396\u2013401 (2008).","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"472_CR26","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/1477-7525-8-102","volume":"8","author":"JCA Trappenburg","year":"2010","unstructured":"Trappenburg, J. C. A. et al. Detecting exacerbations using the Clinical COPD Questionnaire. Health Qual. Life Outcomes 8, 102\u2013102 (2010).","journal-title":"Health Qual. Life Outcomes"},{"key":"472_CR27","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1586\/ers.13.16","volume":"7","author":"JA Trigueros Carrero","year":"2013","unstructured":"Trigueros Carrero, J. A. How should we define and classify exacerbations in chronic obstructive pulmonary disease? Expert Rev. Respir. Med. 7, 33\u201341 (2013).","journal-title":"Expert Rev. Respir. Med."},{"key":"472_CR28","doi-asserted-by":"publisher","first-page":"PA1019","DOI":"10.1183\/13993003.00083-2016","volume":"48","author":"F Rassouli","year":"2016","unstructured":"Rassouli, F., Pfister, M., Baty, F., Widmer, S. & Brutsche, M. Telehealthcare in COPD\u2014a feasibility trial. Eur. Respir. J. 48, PA1019 (2016).","journal-title":"Eur. Respir. J."},{"key":"472_CR29","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1016\/j.rmed.2009.03.017","volume":"103","author":"ZM Sund","year":"2009","unstructured":"Sund, Z. M., Powell, T., Greenwood, R. & Jarad, N. A. Remote daily real-time monitoring in patients with COPD\u2014a feasibility study using a novel device. Respir. Med. 103, 1320\u20131328 (2009).","journal-title":"Respir. Med."},{"key":"472_CR30","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1016\/j.bspc.2015.05.001","volume":"21","author":"YA Amrulloh","year":"2015","unstructured":"Amrulloh, Y. A., Abeyratne, U. R., Swarnkar, V., Triasih, R. & Setyati, A. Automatic cough segmentation from non-contact sound recordings in pediatric wards. Biomed. Signal Process. Control 21, 126\u2013136 (2015).","journal-title":"Biomed. Signal Process. Control"},{"key":"472_CR31","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1109\/TBME.2014.2381214","volume":"62","author":"K Kosasih","year":"2015","unstructured":"Kosasih, K., Abeyratne, U. R. & Swarnkar, V. Wavelet augmented cough analysis for rapid childhood pneumonia diagnosis. IEEE Trans. Biomed. Eng. 62, 1185\u20131194 (2015).","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"472_CR32","unstructured":"Abeyratne, U., Swarnkar, V. & Amrulloh, Y. Method and Apparatus for Processing Patient Sounds. in Edited by IP Australia. (Australia, 2018)."},{"key":"472_CR33","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1183\/09031936.05.00034805","volume":"26","author":"MR Miller","year":"2005","unstructured":"Miller, M. R. et al. Standardization of spirometry. Eur. Respir. J. 26, 319\u2013338 (2005).","journal-title":"Eur. Respir. J."}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-021-00472-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-021-00472-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-021-00472-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T13:55:47Z","timestamp":1670075747000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-021-00472-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,2]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["472"],"URL":"https:\/\/doi.org\/10.1038\/s41746-021-00472-x","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2020.12.13.20247486","asserted-by":"object"}]},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,2]]},"assertion":[{"value":"10 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 June 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 July 2021","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The original version of this Article contained an error in the email address of the corresponding author Paul Porter. This has now been corrected in both the PDF and HTML versions of the Article.","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"ResApp Health provided funding to support the Breathe Easy Program at JHC and UQ. Joondalup Health Campus provided office space, IT services, and consumables in kind. P.P., S.C. and U.A. are scientific advisors of ResApp Health (RAP). P.P. and U.A. are shareholders in RAP. U.A. was RAP\u2019s Chief Scientist. RAP is an Australian publicly listed company commercializing the technology under license from the University of Queensland, where U.A. is employed. U.A. is a named inventor of the UQ technology. V.S. and J.W. are employees of ResApp Health. N.B., J.B., C.S. and P.D. declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"107"}}