Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of hospitalization in the US. Exacerbations - a worsening or flare up of symptoms - cause most COPD hospitalizations. Since most exacerbations can be treated with changes of inhalers and/or oral medications, at-home detection of lung function deterioration may facilitate earlier intervention and help delay or prevent hospitalizations. The Standards of Care for monitoring lung function are spirometry, plethysmography, and CT scan. However, these are expensive methods and unsuited for continuous monitoring or at-home use. Various patient self-monitoring approaches have been tried, for example, pulse oximetry, respiratory rate monitoring, and peak flow metering, but their efficacy in reducing hospitalizations has been limited. A common finding for all forms of COPD is air trapping, defined, as an abnormal increase in the volume of air remaining in the lungs after exhalation is complete. A body of evidence definitively shows that air trapping increases during exacerbations and decreases when exacerbations resolve. Recent reports show that air trapping is an earlier harbinger of deteriorating lung function than spirometric changes, and can be measured by low-frequency ultrasound (1-40 kHz). Acoustic monitoring of air trapping could provide clinicians with a non- invasive tool when medical intervention is needed to avoid unnecessary ER visits and hospitalizations. Respira Labs has developed a low-cost, non-invasive, acoustic-based wearable device that can continually monitor lung resonance: Sylvee. The device uses known acoustic-based technology with machine- learning algorithms to detect minor changes in lung resonance, which our preliminary results suggest correspond to changes in air trapping. The overall objective of this project is to validate Sylvee's air trapping algorithms in a cohort of 20 healthy controls and 40 COPD patients with and without air trapping, respectively. In Aims 1 and 2, we will miniaturize and add sensors to the Sylvee device and develop a user interface (UI) and a mobile application. In Aims 3 and 4, we will create an Air Trapping Index Report and validate it in a cross-sectional study vis-à-vis whole body plethysmography as a control. Results of this project provide a go/no-go development decision based on device function. We can apply these results in STTR Phase II, in a larger clinical study to evaluate Sylvee as an at-home monitoring system, with a goal of reducing hospitalizations by at least 30%. Ultimately, Sylvee will allow physicians to remotely monitor their patients' lung function and adjust their medications to reduce healthcare costs and improve patients' quality of life.
Public Health Relevance Statement: PROJECT NARRATIVE More than 12 million Americans have been diagnosed with COPD, and another 17 million may have COPD, but are unaware of it. By 2020, the costs associated with COPD are estimated to be $72B billion per year, of which with ~50% are the costs of spent on ER visits and hospitalizations. The goal of this proposal is to establish and validate a seamless and non-obtrusive wearable that measures abnormal air trapping via a novel acoustic technology, which would reduce hospitalizations through at-home monitoring of lung function.
Project Terms: accurate diagnosis; Acoustics; Activities of Daily Living; Adult; Air; air monitoring; Algorithmic Analysis; Algorithms; American; Asthma; base; Bluetooth; Bronchoconstriction; Caring; Cellular Phone; Chronic Bronchitis; Chronic Obstructive Airway Disease; Clinic; Clinical; Clinical Data; Clinical Research; Clinical Trials; cloud based; cohort; Computer software; cost; Cross-Sectional Studies; Data; Data Analyses; design; Detection; Deterioration; Development; Device Designs; Devices; Diagnosis; Disease Progression; Dyspnea; Early Intervention; Edema; Emergency department visit; Exhalation; experience; Exposure to; Flare; Frequencies; Functional disorder; Future; General Hospitals; Goals; Health; Health Care Costs; Heart Rate; Home environment; Hospitalization; Hospitals; Humidity; improved; indexing; Individual; Inhalators; Intervention; Laboratories; Lung; Machine Learning; machine learning algorithm; Measurement; Measures; Medical; Medical center; Medical History; meter; Methods; microphone; Military Personnel; Miniaturization; miniaturize; Minor; mobile application; Monitor; Morbidity - disease rate; mortality; Mucous body substance; Noise; novel; Oral; Oxygen saturation measurement; ozone exposure; Particulate; Patients; Pharmaceutical Preparations; Phase; Physicians; Physiology; Plethysmography; Population; prevent; prototype; Pulmonary Emphysema; Pulmonary function tests; Pulse Oximetry; Quality of life; Questionnaires; recruit; Refractory; Regulatory Pathway; Reporting; respiratory; Respiratory Muscles; Respiratory physiology; Risk; Running; San Francisco; screening; Secure; sensor; Signal Transduction; Small Business Technology Transfer Research; smartphone Application; Smoker; software development; Spirometry; Standardization; success; Symptoms; System; Technology; Temperature; Testing; Therapeutic Intervention; Time; tool; Translating; Ultrasonography; usability; user-friendly; Veterans; wearable device; Whole Body Plethysmography; Wireless Technology; X-Ray Computed Tomography
