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Domiciliary Cough Monitoring for the Prediction of COPD Exacerbations

Crooks, Michael G.; den Brinker, Albertus C.; Thackray-Nocera, Susannah; van Dinther, Ralph; Wright, Caroline E.; Morice, Alyn H.


Albertus C. den Brinker

Susannah Thackray-Nocera

Ralph van Dinther

Caroline E. Wright


Introduction: Acute exacerbations of COPD (AE-COPD) are a leading cause of health service utilisation and are associated with morbidity and mortality. Identifying the prodrome of AE-COPD by monitoring symptoms and physiological parameters (telemonitoring) has proven disappointing and false alerts limit clinical utility. We report objective monitoring of cough counts around AE-COPD and the performance of a novel alert system identifying meaningful change in cough frequency. Methods: This prospective longitudinal study of cough monitoring included chronic obstructive pulmonary disease (COPD) patients experienced in telemonitoring that had two or more AE-COPD in the past year. Participants underwent cough monitoring and completed a daily questionnaire for 90 days. The automated system identified deteriorating trends in cough and this was compared with alerts generated by an established telemonitoring questionnaire. Results: 28 patients [median age 66 (range 46–86), mean FEV-1% predicted 36% (SD 18%)] completed the study and had a total of 58 exacerbations (43 moderate and 15 severe). Alerts based on cough monitoring were generated mean 3.4 days before 45% of AE-COPD with one false alert every 100 days. In contrast, questionnaire-based alerts occurred in the prodrome of 88% of AE-COPD with one false alert every 10 days. Conclusion: An alert system based on cough frequency alone predicted 45% AE-COPD; the low false alert rate with cough monitoring suggests it is a practical and clinically relevant tool. In contrast, the utility of questionnaire-based symptom monitoring is limited by frequent false alerts.


Crooks, M. G., den Brinker, A. C., Thackray-Nocera, S., van Dinther, R., Wright, C. E., & Morice, A. H. (2021). Domiciliary Cough Monitoring for the Prediction of COPD Exacerbations. Lung, 199(2), 131-137.

Journal Article Type Article
Acceptance Date Mar 4, 2021
Online Publication Date Apr 7, 2021
Publication Date 2021-04
Deposit Date May 10, 2022
Publicly Available Date May 12, 2022
Journal Lung
Print ISSN 0341-2040
Electronic ISSN 1432-1750
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 199
Issue 2
Pages 131-137
Keywords Chronic obstructive pulmonary disease; COPD; Exacerbation; Cough; Telehealth
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© The Author(s) 2021.
Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

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