Voice changes measured with a mobile phone can signal a flare up in asthma or COPD

Voice changes, that can be recorded and measured with a mobile phone app, can signal a flare up in symptoms for people with asthma or Chronic Obstructive Pulmonary Disease (COPD), according to a study published in ERJ Open Research [1].

A flare up of asthma or COPD, known as an exacerbation, means symptoms such as difficulty breathing, coughing and phlegm become suddenly worse. They can interfere with patient’s everyday activities and, without prompt medical care, they can become dangerous.

Researchers say that, in the future, it may be possible to use a daily voice check to monitor for the earliest sign of a flare up, meaning treatment can be given as soon as possible.

The research was led by Dr Sami Simons, assistant professor at Maastricht University and consultant respiratory physician at Maastricht University Medical Center, the Netherlands. He said: “On top of their daily symptoms, many people with asthma or COPD suffer from sudden increases in symptoms called exacerbations. These can be frightening, and they can lead to longer-term deterioration and increase the risk of dying.

“People are often at home or work when exacerbations start, and they usually need to get into a hospital or clinic for testing. This means there’s a delay and the patient’s suffering is prolonged. Early on in my career I was told that the voice is different during a flare-up. Now, the rise of artificial intelligence means it’s possible to perform sophisticated analysis to find patterns in audio recordings. Capturing voice via a mobile phone is the next logical step to detect deteriorations in asthma or COPD at home and on time.”

The research included 38 people with COPD and 35 people with asthma, who were being treated at Maastricht University Medical Center or the Laurentius Hospital, Roermond, the Netherlands. Over the course of 12 weeks, participants were asked to use a specially designed app to record and analyse their voice daily. To do this, each person would record themselves speaking a long ‘a’ sound, then either reading out a short piece of text or answering a question. They were also asked to complete a daily questionnaire to indicate whether their symptoms were flaring up.

Comparing the voice sounds with the data on symptom flare ups, researchers found that, at the very beginning of a flare up, people’s voices deteriorated in terms of tone, or pitch, the number of pauses and voice quality. They also found that these measures improved as the flare-ups subsided.

Dr Simons explained: “We found that voice significantly changes during an exacerbation of asthma or COPD, and that this occurs as early as the first day that symptoms deteriorate. As the airways constrict during an exacerbation, the air that passes the vocal folds is limited. This weakens normal the normal vibration of the vocal folds, making it harder to keep the voice steady. As a result, the voice of someone with an exacerbation sounds ‘breathier’ and ‘rough’.

“We were able to capture these changes in the home environment of patients with asthma and COPD using an app on their own mobile phone. Our research suggests that in the future people with asthma or COPD may use their voice to detect if they have an exacerbation and react accordingly.”

The TACTICAS app (Telemonitoring for Asthma and COPD Through voICe AnalysiS) was co-designed with patients and a start-up called Zana Technologies. It is currently only available for research purposes, but Dr Simons and his team have created a website (www.speaktoCOPD.com) to explain how the voice technology works and how people can contribute to the research by donating their voice.

Building on their findings, the researchers have now developed machine learning algorithms that can detect exacerbations based on voice changes as early as three days before symptoms show. They are now testing this technology in two new studies: the VOCAL study in Brazil and the SPEAK study in the Netherlands.

Dr Marc Miravitlles, Vice President of the European Respiratory Society, Senior Researcher and Consultant at Vall d’Hebron University Hospital, Barcelona, Spain who was not involved in the research, said: “When symptoms of asthma or COPD suddenly flare up, we want patients to get treatment as soon as possible. Being able to spot a flare up, or even anticipate it by a few days, could be really valuable in terms of reducing symptoms such as breathlessness or coughing as well as lowering the risk of lung damage, hospital admission or death.

“The idea of using a mobile phone to record and analyse patients’ voices for signs of a flare up is very appealing. If follow-up studies are positive, this technology could allow better monitoring and care for patients with asthma or COPD via a mobile phone wherever they are in the world. This is a good example of how new technologies and AI could really improve the quality of life of our patients with chronic respiratory diseases.”

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Notes to editors

[1] ‘Voice as biomarker for early exacerbation detection in asthma and COPD: the TACTICAS study’, by Loes van Bemmel et al, ERJ Open Research 2026; in press (https://doi.org/10.1183/23120541.01737-2025).

Funding: The TACTICAS study was financially supported by unrestricted research grants from Boehringer Ingelheim and AstraZeneca. Loes van Bemmel was financially supported by a research grant from the Dutch Lung Foundation.