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Home Cough Monitoring Reveals Higher Nighttime Cough Burden in Children With Cystic Fibrosis Compared With Healthy
Lilah D Melzer1, Tim Vigers2, Elinor T Hanley2
1Department of Pediatrics, Barbara Bush Children's Hospital, MaineHealth, Portland, Maine, USA.
Insights
Children with cystic fibrosis (CF) coughed more frequently at night than healthy children, even when on advanced treatment. A bedside cough monitor showed feasibility for tracking cough in CF patients.
Area of Science:
- Pediatric Pulmonology
- Biomedical Engineering
- Digital Health
Background:
- Remote health monitoring, including cough monitors, aids in tracking health status changes in children with cystic fibrosis (CF).
- Assessing the feasibility of bedside cough monitors is crucial for longitudinal health tracking in pediatric CF patients.
- Hypothesis: Children with CF (cwCF) exhibit higher baseline cough frequency than healthy controls (HC), with increased coughing during pulmonary exacerbations (PEx).
Purpose of the Study:
- To evaluate the feasibility of using a passive bedside cough monitor for children with cystic fibrosis.
- To compare nighttime cough frequency between cwCF and HC.
- To explore the potential of cough monitoring for detecting changes during pulmonary exacerbations.
Main Methods:
- A feasibility study involving 40 children (20 cwCF, 20 HC) using bedside cough monitors for 3 months.
- Continuous audio data captured during sleep, analyzed for cough events using a proprietary algorithm (CurieAi).
- Multivariable modeling compared baseline cough frequency (coughs per night) between cwCF and HC groups.
Main Results:
- The study enrolled 40 children (20 cwCF, 20 HC), aged 2-18 years, between February and August 2024.
- Cough monitors captured data on over 82% of nights, demonstrating high feasibility.
- Children with CF were significantly more likely to cough at least once per night compared to HC (IRR=0.279, p=0.02).
Conclusions:
- A passive cough monitor effectively detected nighttime coughing in both children with CF and healthy controls.
- Children with CF on elexacaftor/tezacaftor/ivacaftor (ETI) treatment showed more nights with cough compared to HC, indicating persistent cough despite advanced therapy.
- Limited data surrounding pulmonary exacerbations prevented analysis of cough frequency changes during these events.
Rational:
Remote health-monitoring technologies such as cough monitors can track longitudinal changes in health status in children with cystic fibrosis (cwCF). We assessed the feasibility of a bedside cough monitor and hypothesized that cwCF would have a higher baseline cough frequency compared to healthy controls (HC), which would increase during pulmonary exacerbations (PEx).
Methods:
Cough monitors capturing continuous audio data during pre-set sleep times were provided for 3 months. Data were analyzed over 3 s intervals using a proprietary algorithm (CurieAi, Santa Clara, CA) to identify cough events. Multivariable modeling was used to compare baseline cough frequency (coughs per night) between cwCF and HC.
Results:
We enrolled 40 children (20 cwCF and 20 HC; median [range] age 11 years [2-18]) between February and August 2024. Most participants were White, 3 (7.5%) identified as Hispanic and/or Latino. CwCF were all treated with elexacaftor/tezacaftor/ivacaftor (ETI); baseline median (range) ppFEV1 was 107% (86%-124%). Data were captured over 82% of nights in the study period (median of 75.5 nights per participant, range 4-106). CwCF were more likely to cough at least once during the night compared to HC (IRR = 0.279, p = 0.02), and cough at a higher, albeit non-statistically significant rate (IRR = 1.805, p = 0.082). We could not determine whether cough frequency changed during PEx due to limited data collection surrounding reported PEx.
Conclusions:
A passive cough monitor detected nighttime cough in cwCF and HC. CwCF with preserved lung function have more nights with cough than HC despite being on elexacator/tezacaftor/ivacaftor (ETI).
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