Across the globe, there are a staggering number of preventable deaths due to respiratory diseases that occur in early childhood.

“Although the numbers are improving year by year, we still have a long way to go,” says Peter Moschovis, MD, MPH, of the Massachusetts General Hospital Division of Global Health and MassGeneral Hospital for Children.

Dr. Moschovis, a pulmonologist, has dedicated his career to improving diagnostic tools and treatment options for children with pneumonia and other respiratory diseases. The leading cause of early childhood death worldwide, pneumonia infections result in the deaths of about 700,000 children under the age of five each year.

The Global Pneumonia Concern

Pneumonia is an infection in the lungs caused by bacteria, viruses or fungi. It can cause inflammation in the air sacs of the lungs, which then fill with fluid or pus, making it difficult to breathe.

With a lack of portable, cost-effective diagnostic tools, and much that is still unknown about short- and long-term health consequences for children who contract pneumonia at a young age, there are many questions that need to be answered to reduce the disease’s death rate.

Moschovis is part of a research team working to develop and validate a smartphone-based app, called ResAppDx, that may one day be able to diagnose pneumonia and other respiratory diseases by analyzing the sound of a patient’s cough.

While the app is still in the testing stages, a system that would allow for quick, remote and inexpensive diagnosis for pneumonia could help get patients into treatment sooner, which could reduce the chances of the disease turning deadly.

Improving Diagnosis at the Point of Care

“One of the reasons children from low income settings in sub-Saharan Africa and South Asia die of pneumonia is because they don’t get properly diagnosed,” says Moschovis. “More than 80 percent of pneumonia deaths occur in village communities where there are no X-ray machines. Children either get misdiagnosed—often with malaria—or get correctly diagnosed too late by the time they are referred to the hospital.”

“The human ear can’t detect the differences in coughs and that’s exactly why we need this technology,” says Moschovis. “When I first heard about this technology, I was intrigued, even if a bit skeptical. But when I saw the preliminary data from Dr. Abeyratne’s group in Australia, I thought the technology might have real promise.”

Testing the ResAppDx Software

To determine whether the app can provide an accurate diagnosis, Moschovis and Abeyratne teamed up with sponsor ResApp to carry out the SMARTCOUGH-C clinical trial. The study, which finished data collection in July, was conducted at three centers—Mass General, Texas Children’s Hospital and Cleveland Clinic. Moschovis and his colleagues enrolled 1,250 pediatric study participants across all three sites.

Although the app didn’t perform as well as the team had hoped in diagnosing pneumonia, Moschovis and his colleagues plan to make improvements for the follow-up study, including refining the study protocol, increasing training and monitoring, creating more objective clinical case definitions and enhancing the app itself. The team plans to begin the follow-up study this fall. 

Both Moschovis and Abeyratne are optimistic that ResAppDx could one day be a valuable tool in developing countries as well as in the United States.

“A radiation-free, inexpensive devise usable at the point of care could potentially spare children from X-rays throughout the world, and over time have applications in population screening, telehealth, as well as in health management in disaster-stricken areas,” says Abeyratne. “In the hands of community healthcare workers, the app may become a potent lifesaving device in remote, resource-poor regions of the world, where most childhood deaths occur.”

Although the number of pneumonia-related deaths is lower here in the United States, there is still much room for innovation, since there is no gold standard for point-of-care diagnosis. Current diagnostic methods rely on a combination of clinical exam, patient history and chest X-ray.

A Passion for Global Health

Moschovis’ interest in global health research stems from his experiences working in developing countries, where he saw firsthand the tremendous disparities in health care.

“I came to Mass General for my residency and stayed for my fellowship because I wanted to learn medicine from the best hospital in the country and make a difference in global health inequality,” he says.

In addition to developing new diagnostic tools, Moschovis’ research also investigates the health outcomes of pneumonia patients. In a first-of-its-kind investigation, he and his team are currently following pneumonia patients in sub-Saharan Africa for five years after infection to study pneumonia’s impact on lung size and function.

“There’s tremendous opportunity in a place like Mass General to innovate and to study disease that can impact children well beyond the U.S.”

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