{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T09:55:14Z","timestamp":1781690114954,"version":"3.54.5"},"reference-count":40,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background\/Objective: To identify respiratory pathology, automated cough counting is frequently proposed. A trial validating an early warning system for exacerbations in chronic obstructive pulmonary disease (COPD) patients was recently concluded successfully. This paper aims to review the critical design choices for converting a cough counter into a patient-friendly continual cough monitor. Furthermore, it provides a basis for a practical reliability metric for continual cough monitoring. Methods: Design choices made in the development of a cough-based alert mechanism called XACT are discussed. A practical approach for reliability assessment is outlined based on cough counts, day-to-day variation and specificity data. Results: In post hoc analysis, it is shown that the described approach enables differentiation between high-quality cough estimates and less reliable data. The approach is used to underpin an earlier cohort subdivision into patients with and without increased cough during exacerbation. Conclusions: The validated alert mechanism has various patient-oriented design choices (unobtrusiveness, privacy-preserving). The examples illustrate how to screen for potential issues in automated cough count data without resorting to laborious annotation. It creates a practical basis for confidence metrics of medical inferences made from cough data, e.g., exacerbation forecasts. The proposed concepts need further validation.<\/jats:p>","DOI":"10.3390\/medsci14020327","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T08:22:56Z","timestamp":1781684576000},"page":"327","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Converting a Cough Counter into a Cough Monitor: A Way Forward?"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1679-7574","authenticated-orcid":false,"given":"Albertus C. den","family":"Brinker","sequence":"first","affiliation":[{"name":"Independent Researcher, NL-5708 DJ Helmond, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6876-0258","authenticated-orcid":false,"given":"Michael G.","family":"Crooks","sequence":"additional","affiliation":[{"name":"Centre for Clinical Science, Hull York Medical School, University of Hull, Cottingham HU16 5JQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6135-9610","authenticated-orcid":false,"given":"Alyn H.","family":"Morice","sequence":"additional","affiliation":[{"name":"Centre for Clinical Science, Hull York Medical School, University of Hull, Cottingham HU16 5JQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5207","DOI":"10.21037\/jtd-2020-icc-003","article-title":"The present and future of cough counting tools","volume":"12","author":"Hall","year":"2020","journal-title":"J. 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