A Breath of Fresh Air for Pulmonary Telemedicine
New advances in mobile sensing and artificial intelligence at the University of Pittsburgh might make monitoring your lung health as easy as talking on your smartphone.
Wei Gao, associate professor of electrical and computer engineering at Pitt’s Swanson School of Engineering, recently received a 5-year, $3.14 million National Institutes of Health (NIH) R01 grant from the National Heart, Lung, and Blood Institute (NHLBI) to deliver diagnostic tools to your smartphone. With co-principal investigator Erick Forno, professor of pediatrics at the Indiana University School of Medicine, the team is developing a pulmonary telemedicine tool involving nearly 1,000 participants in clinical studies at Pitt and Indiana University.
Even with asthma affecting about 1 in 12 people in the United States and chronic lower respiratory diseases representing the sixth leading cause of death in the country, diagnostic tools like spirometry are hard to come by. They’re typically only administered in the doctor’s office, and at-home tools for more consistent screenings are burdensome and expensive.
“There’s a great need to use telemedicine outside the clinic to continuously monitor and evaluate pulmonary disease conditions and progress, especially in regions with limited healthcare access.” Gao said. “There are some existing devices, but they are very expensive, inaccurate, and require very forced breathing maneuvers that are difficult for children, the elderly, and even our healthiest patients.”
Gao’s team hopes to combat these barriers with AWARE (Acoustic WAveform Respiratory Evaluation), which uses acoustic sensing and machine learning techniques to transform everyday smartphones into a fully functional pulmonary telemedicine examination device. AWARE utilizes a smartphone’s existing speakers and microphones to accurately identify pulmonary diseases, closely estimate lung function, and adaptively detect deviations from normal that are associated with disease exacerbations.
“We turn your phone’s speakers and microphones into a sensing device similar to sonar, then use a BPA-free 3D printed plastic mouthpiece to direct these acoustic signals from the phone to people's airways,” Gao said. “Then, we analyze the reflected signal to get to know the shapes and conditions of the airways, and we use machine learning and biostatistical algorithms to analyze the refracted signals.”
Gao, who develops integrated sensing and AI solutions for smart health applications, is working with Wei Chen, professor of pediatrics, biostatistics and human genetics at Pitt’s School of Public Health, to develop the technology behind the product and create AWARE as a screening tool to help both doctors and patients keep track of lung health in better detail. For Forno, one of AWARE’s most exciting possibilities is allowing each individual to be their own “control” for more personalized and accurate treatment.
“As a pulmonologist, I think the longitudinal impact and the ability to do this over time is going to be very important. I could have a patient whose normal lung function is 125 percent, but if this is the first time I see them and they happen to be 83 percent, I'm going to think that's within their normal range even though it's 40 points lower than what they should be,” Forno said. “If this becomes a long-term use product, then I would learn what the normal is for each person I treat and more accurately detect what's outside of their normal range.”
AWARE would also make it easy to transmit the data from the smartphone directly to the hospital so clinicians can increase medication or alert patients to visit them if their condition worsens.
“There's a fair amount of literature that shows that changes in lung health can happen before you even notice, so if your lung function is stable, sometimes it starts dropping before you feel it,” Forno said. “This is something where, if people get used to doing this two or three times a week as part of their usual routine, we hope AWARE can pick up the signals before they get sick.”
Once they complete five years of clinical studies and product development, Gao plans to specialize and commercialize AWARE by tailoring their techniques to specific patient groups.
“One of our target groups is infants with airway system defects,” Gao said. “They need monitoring devices without needing to insert tubes into their lungs, and this will be a technical challenge for us because the tube and the mouthpiece must be much smaller than what we're currently using.”
Both Gao and Forno are excited about the interdisciplinary aspect of the project, and have gained steam by winning PInCh awards and earlier grants to ramp up AWARE’s possibilities, which has already seen interest from insurance companies, medical technology companies, and clinicians.
“This project is a perfect example of multidisciplinary research,” Forno said. “I had some ideas that I would have never been able to take into practice without the technical skills, and Dr. Gao and Dr. Chen had all the technical skills we needed to bring these clinical ideas to reality.”