Skip to main content
Log in

New Developments in the Objective Assessment of Cough

  • Published:
Lung Aims and scope Submit manuscript

Abstract

A variety of different methods are available for measuring cough. In clinical practice and most clinical trials subjective reporting of cough is relied upon, using scoring systems or visual analog scores (VAS). Although these measures give an indication of patients’ perceptions of the severity of the symptom, they may be unreliable because they are influenced by other factors such as mood, vigilance, and expectations. An objective measure of cough would therefore be a valuable tool. In the last decade advances in computer technology and the availability of portable digital sound recording devices have resulted in a resurgence of interest in developing ambulatory systems for recording cough. The ultimate goal is an automated detection system of use in the wide variety of conditions that cause cough. Multidisciplinary teams of researchers around the world are applying techniques such as neural networks, voice recognition models, and other signal processing techniques to this problem. The main challenge is achieving high sensitivity with good discrimination of noncough signals. For cough sound detection, this is confounded by both the variability of the acoustics of cough sounds within and between individuals and the amount and variety of speech sounds that must be discriminated. Significant progress is being made and it is likely that accurate automated objective monitoring systems will be available in the near future. These systems have the potential to change the way cough is measured in clinical practice and clinical trials, allowing a better understanding of the effect of existing and novel treatments on this troublesome symptom.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Dicpinigaitis PV, Tso R, Banauch G (2006) Prevalence of depressive symptoms among patients with chronic cough. Chest 130(6):1839–1843

    Article  PubMed  Google Scholar 

  2. McGarvey LP, Carton C, Gamble LA, Heaney LG, Shepherd R, Ennis M, MacMahon J (2006) Prevalence of psychomorbidity among patients with chronic cough. Cough 2:4

    Article  PubMed  Google Scholar 

  3. French CL, Irwin RS, Curley FJ, Krikorian CJ (1998) Impact of chronic cough on quality of life. Arch Intern Med 158(15):1657–1661

    Article  PubMed  CAS  Google Scholar 

  4. Smith JA, Owen EC, Jones AM, Dodd ME, Webb AK, Woodcock A (2006) Objective measurement of cough during pulmonary exacerbations in adults with cystic fibrosis. Thorax 61(5):425–429

    Article  PubMed  CAS  Google Scholar 

  5. Eccles R (2002) The powerful placebo in cough studies? Pulm Pharmacol Ther 15(3):303–308

    Article  PubMed  CAS  Google Scholar 

  6. Lee PC, Jawad MS, Hull JD, West WH, Shaw K, Eccles R (2005) The antitussive effect of placebo treatment on cough associated with acute upper respiratory infection. Psychosom Med 67(2):314–317

    Article  PubMed  Google Scholar 

  7. Decalmer S, Webster D, Kelsall A, McGuiness K, Woodcock A, Smith JA (2007) Chronic cough: how do cough reflex sensitivity and subjective assessments correlate with objective cough counts during ambulatory monitoring? Thorax 62:329–334

    Article  PubMed  Google Scholar 

  8. Hsu JY, Stone RA, Logan-Sinclair RB, Worsdell M, Busst CM, Chung KF (1994) Coughing frequency in patients with persistent cough: assessment using a 24 hour ambulatory recorder. Eur Respir J 7(7):1246–1253

    Article  PubMed  CAS  Google Scholar 

  9. Marsden P, Naylor J, Webster D, Kelsall A, Woodcock A (2007) Subjective and objective measures of cough frequency and cough-specific quality of life in asthma patients [abstract]. Eur Respir J (Suppl 51), September 2007 16s E270

  10. Smith J, Owen E, Earis J, Woodcock A (2006) Cough in COPD: correlation of objective monitoring with cough challenge and subjective assessments. Chest 130(2):379–385

    Article  PubMed  Google Scholar 

  11. French CT, Irwin RS, Fletcher KE, Adams TM (2002) Evaluation of a cough-specific quality-of-life questionnaire. Chest 121(4):1123–1131

    Article  PubMed  Google Scholar 

  12. Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MD, Pavord ID (2003) Development of a symptom-specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ). Thorax 58(4):339–343

    Article  PubMed  CAS  Google Scholar 

  13. Korpas J, Sadlonova J, Vrabec M (1996) Analysis of the cough sound: an overview. Pulm Pharmacol 9(5–6):261–268

    Article  PubMed  CAS  Google Scholar 

  14. Chang AB, Newman RG, Phelan PD, Robertson CF (1997) A new use for an old Holter monitor: an ambulatory cough meter. Eur Respir J 10(7):1637–1639

    Article  PubMed  CAS  Google Scholar 

  15. Fontana GA, Widdicombe J (2007) What is cough and what should be measured? Pulm Pharmacol Ther 20(4):307–312

    Article  PubMed  CAS  Google Scholar 

  16. Widdicombe J, Fontana G (2006) Cough: what’s in a name? Eur Respir J 28(1):10–15

    Article  PubMed  CAS  Google Scholar 

  17. Murata A, Taniguchi Y, Hashimoto Y, Kaneko Y, Takasaki Y, Kudoh S (1998) Discrimination of productive and non-productive cough by sound analysis. Intern Med 37(9):732

    Article  PubMed  CAS  Google Scholar 

  18. Smith JA, Ashurst HL, Jack S, Woodcock AA, Earis JE (2006) The description of cough sounds by healthcare professionals. Cough 2:1

    Article  PubMed  Google Scholar 

  19. Morice AH, Fontana GA, Sovijarvi AR, Pistolesi M, Chung KF, Widdicombe J, O’Connell F, Geppetti P, Gronke L, De Jongste J, Belvisi M, Dicpinigaitis P, Fischer A, McGarvey L, Fokkens WJ, Kastelik J, ERS Task Force (2004) The diagnosis and management of chronic cough. Eur Respir J 24(3):481–92

    Article  PubMed  CAS  Google Scholar 

  20. Kelsall A, Webster D, Brown N, Mcguinness K, Woodcock A, Smith J (2007) How to quantify coughing? Correlations with quality if life in patients with chronic cough [abstract]. Thorax 62(Suppl 3):A106;P115

  21. Smith J (2007) Ambulatory methods for recording cough. Pulm Pharmacol Ther 20(4):313–318

    Article  PubMed  CAS  Google Scholar 

  22. Corrigan DL, Paton JY (2003) Pilot study of objective cough monitoring in infants. Pediatr Pulmonol 35(5):350–357

    Article  PubMed  CAS  Google Scholar 

  23. Barry SJ, Dane AD, Morice AH, Walmsley AD (2006) The automatic recognition and counting of cough. Cough 2:8

    Article  PubMed  Google Scholar 

  24. Morice AH, Fontana GA, Belvisi MG, Birring SS, Chung KF, Dicpinigaitis PV, Kastelik JA, McGarvey LP, Smith JA, Tatar M, Widdicombe J, European Respiratory Society (ERS) (2007) ERS guidelines on the assessment of cough. Eur Respir J 29(6):1256–1276

    Article  PubMed  CAS  Google Scholar 

  25. Coyle MA, Keenan DB, Henderson LS, Watkins ML, Haumann BK, Mayleben DW, Wilson MG (2005) Evaluation of an ambulatory system for the quantification of cough frequency in patients with chronic obstructive pulmonary disease. Cough 1:3

    Article  PubMed  Google Scholar 

  26. Matos S, Birring SS, Pavord ID, Evans DH (2006) Detection of cough signals in continuous audio recordings using hidden Markov models. IEEE Trans Biomed Eng 53(6):1078–1083

    Article  PubMed  Google Scholar 

  27. Matos S, Birring SS, Pavord ID, Evans DH (2007) An automated system for 24-h monitoring of cough frequency: the leicester cough monitor. IEEE Trans Biomed Eng 54(8):1472–1479

    Article  PubMed  Google Scholar 

  28. McGuinness K, Kelsall A, Lowe J, Woodcock A, Smith JA (2007) Automated cough detection: a novel approach [abstract]. Am J Resp Crit Care Med 175:A381

    Google Scholar 

  29. McGuinness K, Morris J, Kelsall A, Woodcock A, Smith JA (2007) The relationship between cough acoustics and the volume inspired prior to coughing [abstract]. Am J Resp Crit Care Med 175:A381

    Google Scholar 

  30. Blondeau K, Dupont LJ, Mertens V, Tack J, Sifrim D (2007) Improved diagnosis of gastro-oesophageal reflux in patients with unexplained chronic cough. Aliment Pharmacol Ther 25(6):723–732

    Article  PubMed  CAS  Google Scholar 

  31. Sifrim D, Dupont L, Blondeau K, Zhang X, Tack J, Janssens J (2005) Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut 54(4):449–454

    Article  PubMed  CAS  Google Scholar 

  32. Everett CF, Morice AH (2007) Clinical history in gastroesophageal cough. Respir Med 101(2):345–348

    Article  PubMed  Google Scholar 

  33. Morice AH, McGarvey L, Pavord I (2006) Recommendations for the management of cough in adults. Thorax 61(Suppl 1):i1–24

    Article  PubMed  Google Scholar 

  34. Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash UB, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Smith Hammond C, Tarlo SM, American College of Chest Physicians (ACCP) (2006) Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest 129(1 Suppl):1S–23S

    Article  PubMed  Google Scholar 

  35. Smith J, Owen E, Earis J, Woodcock A (2006) Effect of codeine on objective measurement of cough in chronic obstructive pulmonary disease. J Allergy Clin Immunol 117(4):831–835

    Article  PubMed  CAS  Google Scholar 

  36. Morice AH, Menon MS, Mulrennan SA, Everett CF, Wright C, Jackson J, Thompson R (2007) Opiate therapy in chronic cough. Am J Respir Crit Care Med 175(4):312–315

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jaclyn Smith.

Additional information

No financial conflicts of interest exist for either author, but the authors are inventors on a patent for novel cough detection methods that is owned by the University Hospital of South Manchester. They also have a collaboration and license agreement with Vitalograph UK Ltd.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Smith, J., Woodcock, A. New Developments in the Objective Assessment of Cough. Lung 186 (Suppl 1), 48–54 (2008). https://doi.org/10.1007/s00408-007-9059-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-007-9059-1

Keywords

Navigation