Asthma is a disease that develops clinically in recurrent seizures with shortness of breath, cough and wheezing, and a feeling of tightness in the chest. Airway strictures develop as a result of chronic inflammation of the airways in asthma. This causes airway narrowing and airflow limitation (bronchial spasm). The resulting bronchial inflammation is generally reversible, but in untreated cases, permanent bronchial stenosis may develop as a result of chronic bronchial inflammation. Chronic inflammation is associated with airway hyperresponsiveness that causes recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing, especially at night or in the early morning. These attacks are characterized by a variable airway spasm that is reversible spontaneously or with treatment. In asthma patients, there is generally a weak correlation between the clinical complaints of chronic and severe cases and the severity of the disease. Therefore, objective measurement methods gain importance in the diagnosis and monitoring of asthma. Asthma is thought to affect approximately 300 million people worldwide. Asthma prevalence was found to be variable between 1-18% in different countries. It is estimated that around 250,000 people die annually in the world due to asthma. In our country, approximately 3.5 million of the population is followed up and treated with the diagnosis of asthma. Asthma affects the society not only economically but also socially. It is an important cause of school and workforce loss all over the world. For this reason, when calculating the cost of asthma to society, hospital and treatment expenses, early deaths due to asthma, loss of work force of patients and their relatives should also be taken into consideration. Cough, shortness of breath, chest pressure, and wheezing are the most common symptoms and are recurrent. Some factors that vary according to the individual trigger the emergence of symptoms. Symptoms may vary seasonally or due to exposure. There is no diagnostic blood test that can reveal asthma. X-ray findings are usually normal. Pulmonary function tests (PFT) performed with or without medication are the most important laboratory method to help the diagnosis in a patient with suspected asthma based on history and clinical features. Airway restriction is shown with PFT. In addition, PFT is applied to evaluate the severity of asthma, to determine the clinical types of asthma, to elucidate the pathogenesis, and to evaluate and follow the treatment effects. Restriction in the airway can change over time. Variability can occur within a day, or between days, months, or seasons. Therefore, variability is an important part of asthma control assessment. Peak Expiratory Flow (PEF)=Peak expiratory flow measurement, which can be done by the patient himself, is used in diagnosis and follow-up to evaluate intraday variability in asthma. PEF measurement is accepted as a helpful practical test in the confirmation and follow-up of asthma diagnosis and treatment follow-up. Although PEFmeter measurement is effort dependent, its reproducibility is high in a cooperative patient. However, since PEF largely reflects flow in large airways, results below FEV1 values of 10-20% are obtained in 30-50% of patients. Where spirometry is not available, measurements with a PEFmeter can be used to measure the bronchodilator response. It has been observed that patients who regularly monitor PEF at home and adjust their treatment accordingly use less and more appropriate drugs. In order for asthmatic patients to be treated effectively, they need to be in good cooperation with the attending physician. The purpose of this cooperation; It is to enable the patient to control his/her own condition under the guidance of his/her doctor, and to gain skills in self-treatment. In this process, it is aimed to determine the patient-specific treatment, to monitor the patient's own asthma control level periodically, and to change the treatment according to the PEF result. However, despite the education given, asthma control can be achieved at 60%. At this point, disruptions or erroneous measurements may develop regarding PEF measurements, which are expected to be made for control purposes or if the patient does not use their medications regularly and effectively. The most important reason for erroneous measurements is that patients who have an attack do not have the inspiratory and expiratory power to perform the PEF and PFT maneuvers due to bronchial spasm. At this point, ancillary tests are needed. Patients with impaired asthma control do not always have the opportunity to access a physician. For this reason, the treatment of patients who cannot be examined is determined by the physician according to the PEF meter measurements and the results of the asthma control questionnaire. According to the 2015 GINA (The Global Initiative for Asthma) report, it is stated that in cases where PFT and PEF measurement cannot be performed, the patient should be evaluated with the asthma control questionnaire history and physical examination findings. The necessity of alternative diagnosis and follow-up methods to support the existing parameters is emphasized.
In our Remote Acoustic Based Asthma Follow-up Decision and Support System project, we aim to increase the level of asthma control, facilitate the determination of patient-specific treatment, eliminate the limitations caused by the fact that PFT measurements are tests that can be applied in the laboratory and PEF measurements are applied in limited numbers during the day, and to prevent patient-related measurement disruptions and erroneous measurements. is targeted. For this purpose, a unique wearable sensor module based on acoustic sensors, which does not require effort and can perform continuous measurement, has been developed. Thanks to this module, symptoms of asthma, respiratory sounds and airway activities can be recorded at any time, the number and times of crisis can be observed in a healthy way, and the effectiveness of treatment can be increased because the course of the disease can be examined at frequent intervals. Since the data of the airway is recorded automatically, the measurements are not made when the patient decides, but continuously and without skipping the critical symptom data, and erroneous measurements are prevented with the auxiliary data created. With the developed sensor module, environmental and lifestyle data are recorded simultaneously, and external factors related to lifestyle that cause changes in the severity of the disease can be determined with the artificial intelligence-based decision support system integrated with the Asthma Tracking Web Platform.
It was observed that asthma was not under control and appropriate medication was not used in the vast majority (60%) of patients who were planned to be treated based on asthma severity classification based on symptoms, PEF and PFT values.
Prof. Dr. Füsun Eyüboğlu
With the developed wearable sensor module; airway activities, symptoms, environmental factors and lifestyle parameters can be monitored continuously, and the relevant data can be transmitted to the Asthma Tracking Web Platform and archived in the cloud architecture. With the Artificial Intelligence Based Decision Support System integrated into the web platform, it is possible to detect changes in asthma severity and to convey critical changes related to the course of the disease to the doctor/hospital as warnings. Thus, it is easier to detect time-dependent changes in weight classification that may be overlooked and symptoms that are not correlated with PFT and PEF measurements. As an asthma monitoring method, the "Asthma Control Questionnaire" is used to evaluate the extent to which their disease is controlled by the treatment given to asthma patients. This survey consists of 6 questions.
- Have you experienced one or more of the following symptoms in the last week?
- Do you experience asthma symptoms more than 2 days a week?
- Have you ever been unable to do your daily work due to asthma?
- Have you ever woken up at night because of asthma?
- Have you taken your rescue medicine more than 2 times a week?
- If you have a PEF meter, has your PEF been lower than ...?