Voice changes may enable early detection of COPD exacerbations
Patients’ voices showed significant changes at start of disease worsening
The voice of people with chronic obstructive pulmonary disease (COPD) becomes more pitched and sounds breathy or hoarse at the early stages of disease exacerbations, which are episodes when symptoms suddenly worsen, according to a pilot study where 28 patients were asked to record their voices every day for about three months.
The results were presented by Loes van Bemmel, PhD, a researcher at Maastricht University Medical Center (UMC) in the Netherlands and the study’s first author, at the European Respiratory Society (ERS) Congress this month in Vienna. The presentation was entitled “Detecting the onset and peak symptoms of exacerbations of COPD by analyzing speech.”
“There were clear differences between patients’ recordings on a normal day and on the first day of an exacerbation,” van Bemmel, said in a press release. “These are preliminary results, so our findings need to be validated in larger numbers of patients with COPD. If we are able to do this, it would pave the way for early detection and diagnosis of exacerbations in the home environment. This would enable patients to manage these events themselves at home.”
COPD is a chronic inflammatory disease of the lungs wherein the airways become blocked, causing cough with mucus, wheezing, and shortness of breath. During exacerbations, patients may have difficulty breathing, which may require treatment or hospitalization.
“After an exacerbation, patients report a lower quality of life, their lung function can decline, and patients are at an increased and prolonged risk for cardiovascular events such as heart attack and stroke,” van Bemmel said.
Frits Franssen, MD, PhD, the head of the department of respiratory medicine at UMC, said if the episodes are identified and treatment is given at an early stage, such risks may be reduced and outcomes may be improved. “Unfortunately, it has proved difficult to detect exacerbations at their onset, since symptoms usually start when patients are at home,” said Franssen, who was not involved in the study.
Saying ‘aah’
Based on information from patients and their families indicating voice changes before and during exacerbations, and the knowledge that respiratory distress affects voice characteristics, that researchers hypothesized that speech analysis could detect early signs of an exacerbation. The researchers analyzed data from patients enrolled in TACTICAS (NL-OMON27652), a study over time that was designed to evaluate whether respiratory discomfort could be captured by voice analyses and whether this could detect exacerbations.
Twenty-eight COPD patients were asked to use a smartphone app to record themselves daily saying “aah” for as long as they could handle in one breath, and then while reading a short paragraph of a story, or answering a question.The participants were asked to complete the recordings along with a daily questionnaire to record their COPD symptoms every day for 12 weeks, or about three months.
Eleven patients completed both tasks, resulting in 1,691 voice recordings. Sixteen COPD exacerbations were detected during the study.
Voice changes were analyzed based on 25 speech parameters, including pitch, voice breaks, and jitter. Voice breaks generally refer to transitions between different vocal registers. Jitter is when the voice sounds breathy or hoarse.
The researchers found the patients’ voices showed significant changes at the early stages of exacerbations, specifically, becoming more pitched right before an exacerbation and more breathy or hoarse when the exacerbation was starting.
“This confirmed our hypothesis that speech changes significantly, even at the very beginning of an exacerbation,” van Bemmel said.
If these findings can be validated in larger studies, “this could lead to a quick and efficient system to alert a patient and their doctor that treatment is needed,” said Franssen, who is also the secretary of the ERS assembly on respiratory clinical care and physiology. “Because it works via a smartphone, voice analysis could be used by anyone, at anytime and anywhere. This could ultimately save money, time and patients’ lives.”
Based on these findings, the research team has established a partnership with researchers at Radboud University Medical Center to create a mobile app called SPEAK to enable people with COPD to detect disease exacerbations through voice changes. Â The app also is intended to help patients manage symptoms at home.
“While every disease is different, speech analysis could potentially help in other respiratory diseases as well,” van Bemmel said. “We suspect there are speech biomarkers for many respiratory diseases.”
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