Characteristics of breath sound in infants with risk factors for asthma development

Characteristics of lung sounds in early infants using automated analysis

A new lung sound analysis software program has been developed. It can automatically select a typical lung sound spectrogram and calculate lung sound parameters using machine learning programs. This study aimed to clarify lung sound characteristics in early infants using this program. Using the program, the characteristics of lung sounds in healthy 1- and 4-month-old infants were examined. The lung sounds were assessed in the supine position for 1-month-old infants and in both the sitting and supine positions for 4-month-old infants. We compared the characteristics of the infant lung sounds with those of healthy 3-year-old children. The lung sound parameters of the 1-month-old infants (n = 58) were affected by gender, height, and birth weight. However, those of the 4-month-old infants (n = 50) obtained in the sitting or supine position were not affected by these factors in the study. The lung sound parameters obtained in the sitting and supine positions were not significantly different, and they were not related to a history of wheezing or allergy. PAP0 was higher for the 1-month-old infants than for the 4-month-old infants, and RPF50p and RPF75p were also higher for the 1-month-old infants than for the 4-month-old infants. The PAP0, FAP0, RPF50p, RPF75p, A3a/AT, and B4a/AT of the 4-month-old infants were significantly higher than those of the 3-year-old children (n = 80).

CONCLUSION

The new program confirmed the specificity of lung sound parameters in early infants. Further studies are needed to clarify why the specificity differs from that of 3-year-old children.

WHAT IS KNOWN

• Lung sound analysis has been evaluated to some extent as safe and straightforward for estimating lung function in toddlers and older humans. However, it has not been applied to early infants.

WHAT IS NEW

• A lung sound analysis method using new analysis software has clarified the characteristics of lung spectra in early infants. This technique may facilitate the early diagnosis and treatment of respiratory diseases in infants.

Automatic Analysis of Lung Sounds in 3-Year-Old Children

INTRODUCTION

In recent years, with the advent of artificial intelligence, clear progress has been made in the clinical application of lung sound analysis techniques.

OBJECTIVE

Using a new software program to analyze pediatric lung sounds using machine learning (ML), we conducted a lung sound survey study of 139 healthy 3-year-old children.

SUBJECTS AND METHODS

All cases were surveyed using the ATS-DLD questionnaire, which mainly included items related to a history of wheezing, diagnosis of asthma, and history of respiratory syncytial virus (RSV) infection, allergies and environment. The characteristics of the lung sounds were examined, along with the results of the questionnaire and lung sound parameters.

RESULTS

Children with a history of wheezing showed a higher maximum inspiratory frequency (FAP0), lower basal power (PAP0) (p < 0.001 and p < 0.001, respectively), and lower RPF50p and RPF75p (p = 0.003 and p = 0.003, respectively), suggesting the enhancement of the high-pitched region of the lung sound spectrum. A similar tendency was observed in children with a history of asthma or RSV infection. Furthermore, in the group of children with a history of wheezing, those with a history of acute respiratory tract infection (ARI) within 1 week were found to have an enhancement of the high-pitched region relative to those without history of ARI.

CONCLUSIONS

By utilizing a new analysis software program using ML, we found that 3-year-old children with a history of wheezing or suspected asthma had characteristic lung sounds even when healthy.

Evaluation of the effect of inhaled β2 agonist on lung sounds of children with acute bronchiolitis

BACKGROUND

Discussions regarding the treatment of acute bronchiolitis are ongoing. In this study, we investigated the effects of bronchodilators in infants with viral bronchiolitis using a lung sound analysis.

METHODS

Subjects were hospitalized children diagnosed with viral acute bronchiolitis who received inhaled short-acting inhaled beta 2-agonist (SABA). Lung sounds were collected before and after SABA inhalation, and imaged and quantified using a dedicated analysis system to objectively evaluate the effects of SABA. Furthermore, we investigated the influence of the child's clinical symptoms (clinical score, SpO2 value, hospitalization days, etc.), past history and family history of allergic diseases on the changes in lung sounds after SABA inhalation.

RESULTS

Twenty-six children (male: female = 16: 10, median age: 11 months) participated in the study, and wheezes on the lung sound spectrogram disappeared or decreased after inhalation of SABA in 57.7% (n = 15). However, no improvement in the low-pitched sounds of the lung spectrogram was evident, and no significant change was observed in the exhalation/inspiration power ratio. Although SpO2 in the group whose wheezes improved due to SABA inhalation was significantly lower than that in the group without improvement (p = 0.008), there were no significant differences in other factors.

CONCLUSION

The lung sound analysis confirmed that wheezes improved after SABA inhalation in half of the infants with acute viral bronchiolitis. However, since there was no improvement in clinical symptoms or low-pitched sounds, it was hypothesized that respiratory dysfunctions were caused by various mechanisms in infants with acute bronchiolitis.

The analysis of lung sounds in infants and children with a history of wheezing/asthma using an automatic procedure

BACKGROUND

Lung sound analysis parameters have been reported to be useful biomarkers for evaluating airway condition. We developed an automatic lung sound analysis software program for infants and children based on lung sound spectral curves of frequency and power by leveraging machine learning (ML) technology.

METHODS

To put this software program into clinical practice, in Study 1, the reliability and reproducibility of the software program using data from younger children were examined. In Study 2, the relationship between lung sound parameters and respiratory flow (L/s) was evaluated using data from older children. In Study 3, we conducted a survey using the ATS-DLD questionnaire to evaluate the clinical usefulness. The survey focused on the history of wheezing and allergies, among healthy 3-year-old infants, and then measured lung sounds. The clinical usefulness was evaluated by comparing the questionnaire results with the results of the new lung sound parameters.

RESULTS

In Studies 1 and 2, the parameters of the new software program demonstrated excellent reproducibility and reliability, and were not affected by airflow (L/s). In Study 3, infants with a history of wheezing showed lower FAP0 and RPF75p (p < 0.001 and p = 0.025, respectively) and higher PAP0 (p = 0.001) than healthy infants. Furthermore, infants with asthma/asthma-like bronchitis showed lower FAP0 (p = 0.002) and higher PAP0 (p = 0.001) than healthy infants.

CONCLUSIONS

Lung sound parameters obtained using the ML algorithm were able to accurately assess the respiratory condition of infants. These parameters are useful for the early detection and intervention of childhood asthma.

Effects of COVID-19 pandemic-associated reduction in respiratory infections on infantile asthma development

Background

It is speculated that the coronavirus disease 2019 (COVID-19) pandemic-associated reduction in the prevalence of respiratory tract infections has influenced the incidence of asthma in young children.

Objectives

We investigated an association between the reduction in viral infections and the reduction in asthma in young children.

Methods

The subjects were infants born in the early stages of the COVID-19 pandemic in Japan, which began in February 2020. A questionnaire survey related to asthma and allergy was conducted at 18 months and 3 years of age. These results were compared to those of age-matched infants during the nonpandemic period.

Results

There were no epidemics of viral infectious diseases until the target child was 18 months old. At 18 months, the incidence of asthma/asthmatic bronchitis diagnosed by physicians in pandemic children was significantly lower than that in nonpandemic children. In 3-year-olds, no marked difference was observed between nonpandemic infants and pandemic children, except for an increase in respiratory syncytial virus infection in pandemic children. In a comparative study of the same children at ages 18 months and 3 years, an increased prevalence of asthma/asthmatic bronchitis was observed in pandemic children. Furthermore, the incidence of asthma after respiratory syncytial virus infection in pandemic infants was significantly lower than that in nonpandemic children.

Conclusion

The COVID-19 pandemic-associated reduction in respiratory tract infections may have reduced the incidence of asthma in early childhood, and respiratory syncytial virus infection after 18 months of age had little effect on the onset of asthma. These results indicate the importance of preventing respiratory tract infections in early infancy.

Lung sound analysis for predicting recurrent wheezing in preschool children

Background

In young healthy children, assessing airflow limitation may be difficult because of narrowing of the airways, which is a pathology of asthma, and responsiveness to bronchodilators.

Objective

We investigated whether lung sound analysis could predict the development of recurrent wheezing (RW), which is one of the signs of asthma.

Methods

In healthy children aged 3 to 24 months, we recorded and analyzed lung sounds before and after inhalation of bronchodilators and conducted a questionnaire survey. The children were followed up and assessed for the development of RW at age 3 years.

Results

Of the 62 patients analyzed, 19 (30.6%) developed RW. The parameters ratio of power and frequency at 50% of the highest frequency of the dB power spectrum (RPF50) and ratio of power and frequency at 75% of the highest frequency of the dB power spectrum (RPF75), calculated by lung sound analysis, were lower in the RW group, with odds ratios of 0.77 (95% CI = 0.61-0.98) and 0.81 (95% CI = 0.66-0.99), respectively. The rate of change of lung sound analysis parameters after bronchodilator inhalation did not differ among the participants as a group; however, in the subgroup of children with a history of atopic dermatitis, the fourth area under the curve (B4) divided by the total area under the curve of 100 Hz to the highest frequency of the dB power spectrum (AT) and difference between the values of the ratio of power and frequency at 50% of the highest frequency of the dB power spectrum (ΔRPF50) were elevated in the RW group (P = .015 and P = .041, respectively). In the subgroup of children with total a IgE level greater than 20 kUA/L, the sensitivities and specificities for predicting the development of RW were 85.7% (95% CI = 48.7-99.3) and 68.8% (95% CI = 44.4-85.8), respectively, when the cutoff value of ΔRPF50 was set at 10.5%.

Conclusion

The method of lung sound analysis allows noninvasive assessment of the airway, including airway hypersensitivity, in young children and may predict the risk of development of RW.

Effect of wheeze and lung function on lung sound parameters in children with asthma

BACKGROUND

In children with asthma, there are many cases in which wheeze is confirmed by auscultation with a normal lung function, or in which the lung function is decreased without wheeze. Using an objective lung sound analysis, we examined the effect of wheeze and the lung function on lung sound parameters in children with asthma.

METHODS

A total of 114 children with asthma (males to females = 80: 34, median age 10 years old) were analyzed for their lung sound parameters using conventional methods, and wheeze and the lung function were checked. The effects of wheeze and the lung function on lung sound parameters were examined.

RESULTS

The patients with wheeze or decreased forced expiratory flow and volume in 1 s (FEV1) (% pred) showed a significantly higher sound power of respiration and expiration-to-inspiration sound power ratio (E/I) than those without wheeze and a normal FEV1 (% pred). There was no marked difference in the sound power of respiration or E/I between the patients without wheeze and a decreased FEV1 (% pred) and the patients with wheeze and a normal FEV1 (% pred).

CONCLUSIONS

Our data suggest that bronchial constriction in the asthmatic children with wheeze similarly exists in the asthmatic children with a decreased lung function. A lung sound analysis is likely to enable an accurate understanding of airway conditions.

Clinical application of a lung sound analysis in infants with respiratory syncytial virus acute bronchiolitis

BACKGROUND

Objective investigation of the characteristics of acute bronchiolitis in infants is important for its diagnosis and treatment.

METHODS

Lung sound data of 50 patients diagnosed with respiratory syncytial virus (RSV) acute bronchiolitis (m:f = 29:21, median of age 7 months), 20 patients with RSV acute respiratory tract infections without acute bronchiolitis (m:f = 10:10, 5 months) and 38 age-matched control infants (m:f = 23:15, 8 months) were analyzed using a conventional method and compared. Furthermore, the relationships between lung sound parameters and clinical symptoms (clinical score, length of hospital stay and SpO2 level) in the bronchiolitis and the non-bronchiolitis patients were examined.

RESULTS

Results of lung sound analysis showed that the inspiratory sound power of patients with RSV respiratory tract infections was low and the expiratory sound power was high compared with those of the controls. When the patients with RSV respiratory tract infections were divided into the bronchiolitis and non-bronchiolitis groups, the expiratory/inspiratory ratio of the bronchiolitis patients was greater than that of the non-bronchiolitis patients. There was no difference in the clinical symptoms, clinical score and length of hospital stay between the bronchiolitis and non-bronchiolitis patients, except for the SpO2 level on admission.

CONCLUSION

Lung sound analysis confirmed that patients with RSV acute bronchiolitis present with marked airway narrowing. Considering these results as a characteristic of acute bronchiolitis, it would be meaningful to reflect it in the improvement of diagnosis, treatment and subsequent management.

Breath sound analyses of infants with respiratory syncytial virus acute bronchiolitis

INTRODUCTION

The reliability of a breath sound analysis using an objective method in infants has been reported.

OBJECTIVE

Breath sounds of infants with respiratory syncytial virus (RSV) acute bronchiolitis were analyzed via a breath sound spectrogram to evaluate their characteristics and examine their relationship with the severity.

SUBJECTS AND METHODS

We evaluated the inspiratory and expiratory breath sound parameters of 33 infants diagnosed with RSV acute bronchiolitis. The sound powers of inspiration and expiration were evaluated at the acute phase and recovery phase of infection. Furthermore, the relationship between the breath sound parameters and the clinical severity of acute bronchiolitis was examined.

RESULTS

Analyses of the breath sound spectrogram showed that the power of expiration as well as the expiration-to-inspiration sound ratio in the mid-frequency (E/I MF) was increased in the acute phase and decreased during the recovery phase. The E/I MF was inversely correlated with the SpO₂ and positively correlated with the severity score.

CONCLUSION

In infants with RSV acute bronchiolitis, the sound power of respiration was large at the acute phase, significantly decreasing in the recovery phase. In 61% of participants, nonuniform, granular bands were shown in the low-pitched region of the expiratory spectrogram.

Lung sound analysis in infants with risk factors for asthma development

BACKGROUND AND OBJECTIVES

Using a lung sound analysis, the prognosis of asthma was investigated in infants with risk factors for asthma development by a long-term observation.

METHODS

A total of 268 infants were included (median age: 8 months old). The lung sound parameters (the ratio of the third and fourth area to the total area under the curve [A3/AT and B4/AT], and the ratio of power and frequency at 50% and 75% of the highest frequency [RPF50 and RPF75]) were evaluated at the first visit. At 3 years old, using a questionnaire, we examined the relationship between the lung sound parameters and risk factors of asthma development.

RESULTS

Among the 268 infants, 175 infants were in good health and 93 had a history of acute respiratory infection (ARI) within 7 days at the first visit. Among the 3- to 12-month-old infants with an ARI, the A3/AT, B4/AT values in those with a history of asthma/asthmatic bronchitis, atopic dermatitis, and atopy were smaller than in the infants without such histories. Among the 13- to 24-month-old infants with an ARI, the A3/AT and B4/AT values in those with a wheezing history were larger than in the infants without such a history.

CONCLUSIONS

The characteristics of the lung sounds in infants with risk factors for asthma development were demonstrated over long-term follow-up. Lung sound analyses may be useful for assessing the airway condition of infants.

A Lung Sound Analysis in Infants with Risk Factors for Asthma During Acute Respiratory Infection

Background: The parameters of lung sounds have been suggested as biomarkers of airway changes. Using a commercially available lung sound analyzer, we investigated the characteristics of the lung sounds in infants with acute respiratory infection (ARI). Methods: Infants with ARI who were 6 to 18 months of age were included in this study. The lung sound parameters, the ratio of the third area and fourth areas to the total area under the curve of the sound spectrum (A₃/A_T and B₄/A_T), and the ratio of power and frequency at 75% and 50% of the highest frequency of the power spectrum (RPF₇₅ and RPF₅₀) were evaluated. With an original Japanese questionnaire based on American Thoracic Society-Division of Lung Disease, the risk factors of asthma development in infants were examined. Results: One hundred ten infants with ARI and 248 infants in good health for comparison were included. All infants were completely analyzed, and then divided into 2 age groups for a stratification analysis (6-12 and 13-18 months). In the overall analysis, among infants with a history of wheezing, recurrent wheezing, allergy, and atopic dermatitis, the values of RPF₅₀ of infants with ARI were significantly lower compared with those without ARI. In the 6- to 12-month-old group, the RPF₅₀ values of atopy-positive infants with ARI were lower compared with those without ARI (P = 0.003). Conclusions: The lung sounds of the infants with asthma-developing risk factors were more affected by ARI than those of infants without risk factors. Analyzing the changes in the lung sounds induced by ARI may be useful for evaluating the characteristics of the airways in infants.

Objective evaluation of wheezing in normal infants

BACKGROUND

To evaluate the frequency of wheezing in infants, the presence of wheezing was examined in normal infants using a breath sound analyzer, METHODS: A total of 443 infants (age range, 3-24 months) were included in the present study. The existence of audible wheezing and faint wheezing/inaudible wheezing-like noises (FW) was confirmed on chest auscultation and a sound spectrogram. The breath sound parameters of the sound spectrum, frequency limiting 99% of power spectrum (F₉₉ ), roll-off from 600 to 1,200 Hz (slope) and spectrum curve indices, total area under the curve of dB data (A₃ /A_T and B₄ /A_T ), and ratio of power and frequency at 50% and 75% of the highest frequency of the power spectrum (RPF₅₀ and RPF₇₅ ) were calculated. Using an original Japanese questionnaire, we examined the characteristics of the airway condition of all infants.

RESULTS

Finally, a total of 398 infants were analyzed in the present study, and 283 were in good health while 115 had acute respiratory infection (ARI) in the last 7 days. No infants had audible wheezing on auscultation. Three infants without ARI (1.1%) and 10 infants with ARI (8.7%) had FW. In the evaluation of breath sound parameters, there were no marked differences between the infants with and without FW.

CONCLUSIONS

Using a breath sound analyzer, wheezing and FW were recognized in only a few infants in good health. Infants recognized to have audible wheezing in daily practice may be at risk of developing recurrent wheezing/asthma.