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Clara: Nocturnal Cough Detection and Asthma Control Prediction

CSS Mobile Asthma Companion

Nocturnal cough is a burdensome asthma symptom. However, knowledge about the prevalence of nocturnal cough in asthma is limited. Furthermore, prior research has shown that nocturnal cough and impaired sleep quality are associated with asthma control, but the association between these two symptoms remains unclear. This study further investigates the potential of these symptoms as markers for asthma control and the accuracy of automated, smartphone-based passive monitoring for nocturnal cough detection and sleep quality assessment.

The study is a multicentre, longitudinal observational study with two stages. Sensor and questionnaire data of 94 individuals with asthma will be recorded for 28 nights by means of a smartphone. On the first and the last study day, a participant’s asthma will be clinically assessed, including spirometry and fractionated exhaled nitric oxide levels. Asthma control will be assessed by the Asthma Control Test and sleep quality by means of the Pittsburgh Sleep Quality Index. In addition, nocturnal coughs from smartphone microphone recordings will be labeled and counted by human annotators. Relatively unrestrictive eligibility criteria for study participation are set to support the external validity of study results. Analysis of the first stage is concerned with the prevalence and trends of nocturnal cough and the accuracies of smartphone-based automated detection of nocturnal cough and sleep quality. In the second stage, patient-reported asthma control will be predicted in a mixed effects regression model with nocturnal cough frequencies and sleep quality of past nights as the main predictors.

In preparation for this main study, several other investigations have been conducted to better understand the state-of-the-art in mobile asthma applications and individuals with asthma (e.g. focus group discussions).

Video Clips


Rassouli, F., Tinschert, P., Barata, F., Steurer-Stey, C., Fleisch, E., Puhan, M., Baty, F., Kowatsch, T., Brutsche, M. (2020) Characteristics of Asthma-related Nocturnal Cough – A Potential New Digital Biomarker, European Respiratory Society International Congress (ERS 2020) (virtual), Barcelona, Spain, September 7-9, 2020. (PDF)

Tinschert, P., Rassouli, F., Barata, F., Steurer-Stey, C., Fleisch, E., Puhan, M., Baty, F., Kowatsch, T., Brutsche, M. (2020) Nocturnal Cough and Sleep Quality to Assess Asthma Control and Predict Attacks, European Respiratory Society International Congress (ERS 2020) (virtual), Barcelona, Spain, September 7-9, 2020. (PDF)

Barata, F., Tinschert, P., Rassouli, F., Brutsche, M., Kotz, D.F., Puhan, M., Fleisch, E., Kowatsch, T. (2020) Automatic recognition, segmentation and sex assignment of nocturnal asthmatic cough and cough epochs in smartphone-based audio recordings: Results from an observational field study, Journal of Medical Internet Research (JMIR), 22(7):e18082, doi: 10.2196/18082 (PDF)

Barata, F., Kipfer, K., Weber, M., Tinschert, P., Fleisch, E., Kowatsch, T. (2019) Towards Device-Agnostic Mobile Cough Detection with Convolutional Neural Networks, 7th IEEE International Conference on Healthcare Informatics (ICHI), Beijing, China. (PDF)

Kowatsch, T., Fischer-Taeschler, D., Putzing, F., Bürki, P., Stettler, C., Chiesa-Tanner, G., Fleisch, E. (2019) Die digitale Pille für chronische Krankheiten, in: Digitale Transformation von Dienstleistungen im Gesundheitswesen VI – Impulse für die Forschung, M. Pfannstiel, P. Da-Cruz and H. Mehlich (eds.), Springer Gabler, Heidelberg, Germany, 205-231. (PDF)

Tinschert, P., Rassouli, F., Barata, F., Steurer-Stey, C., Fleisch, E., Puhan, M., Brutsche, M., Kowatsch, T. (2019 Prevalence of Nocturnal Cough in Asthma and its Potential as a Marker for Asthma Control (MAC) in Combination with Sleep Quality: Protocol of a Smartphone-based, Multi-Centre, Longitudinal Observational Study with Two Stages, BMJ Open 9:e026323. (PDF)

Tinschert, P., Barata, F., Kramer, J., Rassouli, F., Steurer-Stey, C., Puhan, M., Brutsche, M., Kowatsch, T. (2019) Don’t Lose Heart: Preliminary Engagement Results in an Ecological Momentary Assessment (EMA) Study Evaluating Digital Biomarkers for Asthma, Abstract presented at the International Society for Research on Internet Interventions (ISRII) Meeting 2019, Auckland, New Zealand. (PDF)

Barata, F., Tinschert, P., Rassouli, F., Baty, F., Brutsche, M., Steurer-Stey, C., Puhan, M., Fleisch, E., Kowatsch, T., Smartphone-based Cough and Sleep Quality Detection, Poster presented at the Applied Machine Learning Days, EPFL, Lausanne, Switzerland. (PDF)

Tinschert, P., Jakob, R., Barata, F., Kramer, J. N., & Kowatsch, T. (2017) The Potential of Mobile Apps for Improving Asthma Self-Management: A Review of Publicly Available and Well-Adopted Asthma Apps JMIR mHealth and uHealth, 5(8), e113. (Link)

Tinschert, P.,Barata, F., Kowatsch, T., (2017) Enhancing Asthma Control through IT: Design, Implementation and Planned Evaluation of the Mobile Asthma Companion, in Leimeister, J.M.; Brenner, W. (Hrsg.): Proceedings der 13th International Conference on Wirtschaftsinformatik (WI 2017), St. Gallen, 1291-1294. (PDF)

Barata, F., Kowatsch, T., Tinschert, P., Filler, A., (2016) Personal MobileCoach: Tailoring Behavioral Interventions to the Needs of Individual Participants, UbiComp ’16 Proceedings of the 2016 ACM International Joint Conference on Pervasive and Ubiquitous Computing: Adjunct  Workshop Designing, Developing, and Evaluating The Internet of Personal Health (IoPH), Heidelberg, Germany, 1089-1094. (PDF)

Related Work

Kowatsch, T., Volland, D., Shih, I., Rüegger, D., Künzler, F., Barata, F., Filler, A., Büchter, D., Brogle, B., Heldt, K., Gindrat, P., Farpour-Lambert, N., l’Allemand, D. (2017) Design and Evaluation of a Mobile Chat App for the Open Source Behavioral Health Intervention Platform MobileCoach, In: Maedche A., vom Brocke J., Hevner A. (eds) Designing the Digital Transformation. DESRIST 2017. Lecture Notes in Computer Science, vol 10243. Springer: Berlin; Germany, 485-489. (Paper-PDF | Poster-PDF | Slide-PDF | Screencast)

Filler, A., Kowatsch, T., Haug, S., Wahle, F., Staake, T. & Fleisch, E. (2015) MobileCoach: A Novel Open Source Platform for the Design of Evidence-based, Scalable and Low-Cost Behavioral Health Interventions – Overview and Preliminary Evaluation in the Public Health Context. Wireless Telecommunications Symposium 2015 (WTS 2015), New York, USA. ***Outstanding Paper Award & Best Graduate Student Paper Award*** PDF


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CDHI Research Team

Dr. Filipe Barata, Dr. Peter Tinschert, Matthias Heuberger, Prof. Dr. Elgar Fleisch & Prof. Dr. Tobias Kowatsch


Mar 2016 – Apr 2020


Prof. Dr. Dr. med. Martin Brutsche & Dr. med. Frank Rassouli (Cantonal Hospital St.Gallen), Prof. Dr. med. Claudia Steurer-Stey & Prof. Dr. med. Milo Puhan (University of Zurich)

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Filipe Barata (Nocturnal Cough Detection) & Peter Tinschert (Asthma Control Prediction)