Chronic Obstructive Pulmonary Disorder (COPD) is an irreversible and progressive disease which is highly heritable. Clinically, COPD is defined using the summary measures derived from a spirometry test but these are not always adequate. Here we show that using the high-dimensional raw spirogram can provide a richer signal compared to just using the summary measures. We design a transformer-based deep learning technique to process the raw spirogram values along with demographic information and predict clinically-relevant endpoints related to COPD. Our method is able to perform better than prior works while being more computationally efficient. Using the weights learned by the model, we make the framework more interpretable by identifying parts of the spirogram that are important for the model predictions. Pairing up with a board-certified pulmonologist, we also provide clinical insights into the different aspects of the spirogram and show that the explanations obtained from the model align with underlying medical knowledge.

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. In the United States, more than 15.7 million Americans have been diagnosed with COPD, with 96% of individuals living with at least one other chronic health condition. It is the 4th leading cause of death in the country. Over 2.2 million patients are admitted to hospitals annually due to COPD exacerbations. Monitoring and predicting patient exacerbations on-time could save their life. This paper presents two different predictive models to predict COPD exacerbation using AI and natural language processing (NLP) approaches. These models use respiration summary notes, symptoms, and vital signs. To train and test these models, data records containing physiologic signals and vital signs time series were used. These records were captured from patient monitors and comprehensive clinical data obtained from hospital medical information systems for tens of thousands of Intensive Care Unit (ICU) patients. We achieved an area under the Receiver operating characteristic (ROC) curve of 0.82 in detection and prediction of COPD exacerbation.

Chronic obstructive pulmonary disease (COPD) is a serious inflammatory lung disease affecting millions of people around the world. Due to an obstructed airflow from the lungs, it also becomes manifest in patients' vocal behaviour. Of particular importance is the detection of an exacerbation episode, which marks an acute phase and often requires hospitalisation and treatment. Previous work has shown that it is possible to distinguish between a pre- and a post-treatment state using automatic analysis of read speech. In this contribution, we examine whether sustained vowels can provide a complementary lens for telling apart these two states. Using a cohort of 50 patients, we show that the inclusion of sustained vowels can improve performance to up to 79\% unweighted average recall, from a 71\% baseline using read speech. We further identify and interpret the most important acoustic features that characterise the manifestation of COPD in sustained vowels.

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung condition that causes airflow obstruction. The existing methods can only detect patients who already have COPD based on obvious features shown in the spirogram (In this article, the spirogram specifically involves measuring Volume-Flow curve time series). Early prediction of COPD risk is vital for monitoring COPD disease progression, slowing it down, or even preventing its onset. However, these methods fail to early predict an individual's probability of COPD in the future based on subtle features in the spirogram. To address this gap, for the first time, we propose DeepSpiro, a method based on deep learning for early prediction of future COPD risk. DeepSpiro consists of four parts. First, we construct Volume-Flow curves guided by Time-Volume instability smoothing (SpiroSmoother) to enhance the stability of the original Volume-Flow curves precisely. Second, we extract critical features from the evolution of varied-length key patches (SpiroEncoder) to capture the key temporal evolution from original high-dimensional dynamic sequences to a unified low-dimensional temporal representation. Third, we explain the model based on temporal attention and heterogeneous feature fusion (SpiroExplainer), which integrates information from heterogeneous data such as spirogram and demographic information. Fourth, we predict the risk of COPD based on the evolution of key patch concavity (SpiroPredictor), enabling accurate prediction of the risk of disease in high-risk patients who are not yet diagnosed, for up to 1, 2, 3, 4, 5 years, and beyond. We conduct experiments on the UK Biobank dataset. Results show that DeepSpiro achieves an AUC value of 0.8328 in the task of detecting COPD. In early prediction tasks, high-risk and low-risk groups show significant differences in the future, with a p-value of <0.001.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide, usually associated with smoking and environmental occupational exposures. Prior studies have shown that current COPD diagnosis (i.e., spirometry test) can be unreliable because the test can be difficult to do and depends on an adequate effort from the testee and supervision of the testor. Moreover, the extensive early detection and diagnosis of COPD is challenging. We address the COPD detection problem by constructing two novel COPD physiological signals datasets (4432 medical records from 54 patients in the WestRo COPD dataset and 13824 medical records from 534 patients in the WestRo Porti COPD dataset), demonstrating their complex coupled fractal dynamical characteristics, and performing a rigorous fractional-order dynamics deep learning analysis to diagnose COPD with high accuracy. We find that the fractional-order dynamical modeling can extract distinguishing signatures from the physiological signals across patients with all COPD stages--from stage 0 (healthy) to stage 4 (very severe). We exploit these fractional signatures to develop and train a deep neural network that predicts the suspected patients' COPD stages based on the input features (such as thorax breathing effort, respiratory rate, or oxygen saturation levels). We show that our COPD diagnostics method (fractional dynamic deep learning model) achieves a high prediction accuracy (98.66% 0.45%) on WestRo COPD dataset and can serve as an excellent and robust alternative to traditional spirometry-based medical diagnosis. Our fractional dynamic deep learning model (FDDLM) for COPD diagnosis also presents high prediction accuracy when validated by a dataset with different physiological signals recorded (i.e., 94.01%

Whilst debilitating breathing disorders, such as chronic obstructive pulmonary disease (COPD), are rapidly increasing in prevalence, we witness a continued integration of artificial intelligence into healthcare. While this promises improved detection and monitoring of breathing disorders, AI techniques are "data hungry" which highlights the importance of generating physically meaningful surrogate data. Such domain knowledge aware surrogates would enable both an improved understanding of respiratory waveform changes with different breathing disorders and different severities, and enhance the training of machine learning algorithms. To this end, we introduce an apparatus comprising of PVC tubes and 3D printed parts as a simple yet effective method of simulating both obstructive and restrictive respiratory waveforms in healthy subjects. Independent control over both inspiratory and expiratory resistances allows for the simulation of obstructive breathing disorders through the whole spectrum of FEV1/FVC spirometry ratios (used to classify COPD), ranging from healthy values to values seen in severe chronic obstructive pulmonary disease. Moreover, waveform characteristics of breathing disorders, such as a change in inspiratory duty cycle or peak flow are also observed in the waveforms resulting from use of the artificial breathing disorder simulation apparatus. Overall, the proposed apparatus provides us with a simple, effective and physically meaningful way to generate surrogate breathing disorder waveforms, a prerequisite for the use of artificial intelligence in respiratory health.

When patients develop acute respiratory failure, accurately identifying the underlying etiology is essential for determining the best treatment, but it can be challenging to differentiate between common diagnoses in clinical practice. Machine learning models could improve medical diagnosis by augmenting clinical decision making and play a role in the diagnostic evaluation of patients with acute respiratory failure. While machine learning models have been developed to identify common findings on chest radiographs (e.g. pneumonia), augmenting these approaches by also analyzing clinically relevant data from the electronic health record (EHR) could aid in the diagnosis of acute respiratory failure. Machine learning models were trained to predict the cause of acute respiratory failure (pneumonia, heart failure, and/or COPD) using chest radiographs and EHR data from patients within an internal cohort using diagnoses based on physician chart review. Models were also tested on patients in an external cohort using discharge diagnosis codes. A model combining chest radiographs and EHR data outperformed models based on each modality alone for pneumonia and COPD. For pneumonia, the combined model AUROC was 0.79 (0.78-0.79), image model AUROC was 0.73 (0.72-0.75), and EHR model AUROC was 0.73 (0.70-0.76); for COPD, combined: 0.89 (0.83-0.91), image: 0.85 (0.77-0.89), and EHR: 0.80 (0.76-0.84); for heart failure, combined: 0.80 (0.77-0.84), image: 0.77 (0.71-0.81), and EHR: 0.80 (0.75-0.82). In the external cohort, performance was consistent for heart failure and COPD, but declined slightly for pneumonia. Overall, machine learning models combing chest radiographs and EHR data can accurately differentiate between common causes of acute respiratory failure. Further work is needed to determine whether these models could aid clinicians in the diagnosis of acute respiratory failure in clinical settings.

Auscultation is a method for diagnosis of especially internal medicine diseases such as cardiac, pulmonary and cardio-pulmonary by listening the internal sounds from the body parts. It is the simplest and the most common physical examination in the assessment processes of the clinical skills. In this study, the lung and heart sounds are recorded synchronously from left and right sides of posterior and anterior chest wall and back using two digital stethoscopes in Antakya State Hospital. The chest X-rays and the pulmonary function test variables and spirometric curves, the St. George respiratory questionnaire (SGRQ-C) are collected as multimedia and clinical functional analysis variables of the patients. The 4 channels of heart sounds are focused on aortic, pulmonary, tricuspid and mitral areas. The 12 channels of lung sounds are focused on upper lung, middle lung, lower lung and costophrenic angle areas of posterior and anterior sides of the chest. The recordings are validated and labelled by two pulmonologists evaluating the collected chest x-ray, PFT and auscultation sounds of the subjects. The database consists of 30 healthy subjects and 45 subjects with pulmonary diseases such as asthma, chronic obstructive pulmonary disease, bronchitis. The novelties of the database are the combination ability between auscultation sound results, chest X-ray and PFT; synchronously assessment capability of the lungs sounds; image processing based computerized analysis of the respiratory using chest X-ray and providing opportunity for improving analysis of both lung sounds and heart sounds on pulmonary and cardiac diseases.

Chronic obstructive pulmonary disease (COPD) is a lung disease where early detection benefits the survival rate. COPD can be quantified by classifying patches of computed tomography images, and combining patch labels into an overall diagnosis for the image. As labeled patches are often not available, image labels are propagated to the patches, incorrectly labeling healthy patches in COPD patients as being affected by the disease. We approach quantification of COPD from lung images as a multiple instance learning (MIL) problem, which is more suitable for such weakly labeled data. We investigate various MIL assumptions in the context of COPD and show that although a concept region with COPD-related disease patterns is present, considering the whole distribution of lung tissue patches improves the performance. The best method is based on averaging instances and obtains an AUC of 0.742, which is higher than the previously reported best of 0.713 on the same dataset. Using the full training set further increases performance to 0.776, which is significantly higher (DeLong test) than previous results.

This paper presents an example of how demographical characteristics of patients influence their susceptibility to certain medical conditions. In this paper, we investigate the association of health conditions to age of patients in a heterogeneous population. We show that besides the symptoms a patients is having, the age has the potential of aiding the diagnostic process in hospitals. Working with Electronic Health Records (EHR), we show that medical conditions group into clusters that share distinctive population age densities. We use Electronic Health Records from Brazil for a period of 15 months from March of 2013 to July of 2014. The number of patients in the data is 1.7 million patients and the number of records is 47 million records. The findings have the potential of helping in a setting where an automated system undergoes the task of predicting the condition of a patient given their symptoms and demographical information.