Cough dynamics in adults receiving tuberculosis treatment

Abstract

Cough is a characteristic symptom of tuberculosis, is the main cause of transmission, and is used to assess treatment response. We aimed to identify the best measure of cough severity and characterize changes during initial tuberculosis therapy. We conducted a prospective cohort of recently diagnosed ambulatory adult patients with pulmonary tuberculosis in two tertiary hospitals in Lima, Peru. Pre-treatment and five times during the first two months of treatment, a vibrometer was used to capture 4-hour recordings of involuntary cough. A total of 358 recordings from 69 participants were analyzed using a computer algorithm. Total time spent coughing (seconds per hour) was a better predictor of microbiologic indicators of disease severity and treatment response than the frequency of cough episodes or cough power. Patients with prior tuberculosis tended to cough more than patients without prior tuberculosis, and patients with tuberculosis and diabetes coughed more than patients without diabetes comorbidity. Cough characteristics were similar regardless of HIV co-infection and for drug-susceptible versus drug-resistant tuberculosis. Tuberculosis treatment response may be meaningfully assessed by objectively monitoring the time spent coughing. This measure demonstrated that cough was increased in patients with TB recurrence or co-morbid diabetes, but not because of drug resistance or HIV co-infection.

Biomarkers That Correlate with Active Pulmonary Tuberculosis Treatment Response: a Systematic Review and Meta-analysis

“…Several blood-based transcriptomic and gene expression signatures were examined as treatment monitoring markers, including the parsimonious 3-gene Sweeney3 signature ( 35 , 85 ), the RISK6 signature ( 69 ), and the RISK11 signature ( 28 ). Two studies explored changes in breath-based markers such as fractional exhaled nitric oxide (FeNO) and volatile organic compounds (VOCs) ( 71 , 88 ), while another study by Lee et al characterized changes in cough frequency throughout treatment ( 55 ). Table 2 summarizes the biomarkers that were included in the detailed quantitative assessment, as well as the transcriptomic signatures.…”

Reimagining the status quo: How close are we to rapid sputum-free tuberculosis diagnostics for all?

“… 25 , 26 Classification technologies are distinct from cough counting, which may have treatment monitoring utility. 113 Triage - Only proof-of-concept studies exist 25 - Smartphone applications are undergoing evaluation (TimBre, 114 Hyfe) 27 , 108 - Promising but too early to tell. - One study with non-TB infected controls obtained a sensitivity of 93% and specificity of 95%.…”

Cough Sounds Recorded via Smart Devices as Useful Non-Invasive Digital Biomarkers of Aspiration Risk: A Case Report

“…Moreover, it is critical for both diagnosis and monitoring of the treatment response. Cough frequency can be associated with infection load and is relevant to disease transmission or conversion rates [ 13 ]. Changes in cough characteristics can reflect evolving pathological situations and can be used to monitor respiratory status in various pulmonary disorders [ 13 , 14 ].…”

“…Cough frequency can be associated with infection load and is relevant to disease transmission or conversion rates [ 13 ]. Changes in cough characteristics can reflect evolving pathological situations and can be used to monitor respiratory status in various pulmonary disorders [ 13 , 14 ]. With the recent advancements in the automatic detection of cough, increased amplitude, frequency, duration, severity, and pattern of cough are relevant features for the automatic detection of respiratory diseases [ 15 ].…”