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Tuberculosis or Covid? AI-based apps analyze coughs, breath and voice

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Tuberculosis or Covid?  AI-based apps analyze coughs, breath and voice

In Germany, the number of cases of tuberculosis has been declining for many years – also thanks to vaccinations. There were only just under 4,000 registered cases in 2021. The situation is different in other countries: In 2022, 1.2 million people died from tuberculosis worldwide, making it the second deadliest infectious disease behind Covid-19.


In order to diagnose cases more quickly, researchers have now developed a smartphone app that can distinguish tuberculosis from other diseases based on the patient’s coughing sound. This procedure is simpler and much cheaper than sampling mucus to look for the disease-causing bacteria. Therefore, it could prove to be a screening tool, especially in low-income countries.

In the study, published in the journal Science Advances, a team of researchers from the United States and Kenya trained and tested their smartphone-based diagnostic tool using cough records they collected at a Kenyan health center: 33,000 spontaneous coughing attacks and 1,200 forced coughing attacks from 149 people with tuberculosis and 46 people with other respiratory diseases. The app’s performance was not good enough to immediately replace conventional diagnostics – because the app was still unable to detect the disease in around 30 percent of tuberculosis patients. But it could be used as an additional screening tool. The earlier people with active tuberculosis are identified and treated, the less likely they are to spread the disease.

The new study is one of dozens that have emerged in recent years that aim to use coughs and other body sounds as “acoustic biomarkers,” sounds that indicate changes in health. The concept has been around for at least three decades, but in the past five years the field has evolved significantly. What has changed most, says Yael Bensoussan, a laryngologist at the University of South Florida, is the increasing use of artificial intelligence, which can be used to analyze a larger amount of data more quickly.

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The corona pandemic alone has spawned 30 or 40 start-ups that deal with the acoustics of coughing, says Bensoussan. AudibleHealthAI, for example, was founded in 2020 and developed an app for diagnosing Covid. The software, called AudibleHealth DX, is currently being reviewed by the US Food and Drug Administration (FDA). Now the company is expanding its offerings to include flu and tuberculosis.

The Australian company ResApp Health has been working on the acoustic diagnosis of respiratory diseases since 2014, long before the pandemic. But when Covid-19 emerged, the company pivoted and developed an audio-based Covid-19 screening test. In 2022, the company announced that the device correctly identified 92 percent of positive Covid cases based on the sound of a patient coughing alone. Shortly thereafter, Pfizer paid $179 million to acquire ResApp.

The approach of the German start-up Audeering also aims in a similar direction of audio-based Covid-19 screening. In collaboration with the University of Augsburg, the company collects voice recordings from healthy and sick test subjects in order to train their AI Soundlab. According to its own information, Audeering analyzes 6,000 parameters of the human voice, which is affected by respiratory diseases. The application is said to detect Covid 19 based on voice with 82 percent accuracy.

Bensoussan is skeptical as to whether such apps will develop into reliable diagnostics. But she says apps that detect coughs – any cough – could prove to be valuable health trackers, even if they can’t pinpoint the cause. Coughs are particularly easy to record with a smartphone. “The cough can be monitored using a smartphone that almost everyone has with them at bedside or in their pocket,” Jamie Rogers, product manager at Google Health, told Time magazine. Google’s latest Pixel smartphones already have cough and snoring detection.

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Yael Bensoussan also believes that cough detection apps could be of great importance for clinical studies in which researchers want to measure coughing, among other things. Until now, doctors often relied on patients’ memories of their cough. An app would be much more accurate: “It’s really easy to record the frequency of coughing from a technical perspective,” she says.

And it’s not just the cough that can provide clues about our health. Bensoussan is leading a $14 million project to develop a comprehensive database of voice, cough and breathing sounds to help develop tools to diagnose cancers, respiratory diseases, neurological and mood disorders, speech disorders and more. The database captures a variety of sounds, including coughing, reading sentences or vowel sounds, inhaling and exhaling.

“One of the big limitations is that many of these studies have private data sets that are secret,” says Bensoussan. This makes it difficult to validate the research results. The database that she and her colleagues are developing will therefore be publicly accessible. She assumes that the first data will be published before June. And as more data becomes available, there will likely be even more apps that can use cough or speech patterns to alert you to health problems. It’s worth keeping your ears open.


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