Voice Biomarkers Show Promise for Asthma, COPD Exacerbation Detection

Voice biomarkers may provide insight into the diagnosis of asthma and chronic obstructive pulmonary disease (COPD), according to a recent study published in ERJ Open Research.¹

Researchers investigated changes in voice before and during an exacerbation, underscoring the importance of early detection in asthma and COPD, which increases the likelihood of positive treatment outcomes. Exacerbations in these diseases can often lead to increased medication use, hospitalization, accelerated disease progression, a higher mortality rate, and an overall lower quality of life. Current self-monitoring practices for asthma and COPD include patient-reported symptoms, among other avenues.² However, new, investigative, remote voice-based biomarker monitoring proposes a non-invasive and cost-effective method of disease monitoring for patients and provides real-time updates for clinicians.¹

TACTICAS Study Explores Speech as a Digital Biomarker for Respiratory Disease

The multi-center prospective cohort Telemonitoring for Asthma and COPD through voICe analysiS (TACTICAS) study was conducted across 2 centers in the Netherlands. Patients were enrolled between January 2022 and May 2024. Eligible participants included those with a guideline-based diagnosis of asthma or COPD without any comorbidities affecting speech production.

The study period lasted 12 weeks, with 4-week check-ins between researchers and participants via phone call to document symptoms or any changes in medication. Baseline lung function parameters and medical history were obtained from electronic health records (EHRs).

Exacerbations were assessed using a 14-item patient-reported-outcome questionnaire called EXACT. An EXACT event was defined as a sustained increase of more than 9 points above baseline for 3 days or more than 12 points for 2 days in a row.

Speech features were assessed and recorded using a model requiring participants to complete 3 speech tasks: sustained vowel ‘a,’ reading text analyzed separately, and spontaneous speech.

Voice Changes May Signal Asthma and COPD Exacerbations Early

The study included 73 participants, 38 with COPD and 35 with asthma. The overall mean age was 62 years. The majority of participants with COPD exhibited a mean forced expiratory volume 1 (FEV1) of 57%, consistent with the Global Initiative for Chronic Obstructive Lung Disease 2. Whereas the majority of patients with asthma exhibited preserved lung function, 31.4% had obstructive ventilatory impairment or an FEV1/forced vital capacity (FVC) less than the lower limit of normal (LLN).

The mean COPD Assessment Test score among participants was 16.9, and the mean asthma-controlled questionnaire (ACQ) score was 4.1.

Of the 73 participants, 35 (48%) experienced at least 1 exacerbation during the study. There were a total of 38 exacerbations captured. Of the 38 exacerbations observed, 30 (79%) were correctly identified using the EXACT questionnaire. The remaining 8 were found through EHR and medication review.

There were a total of 23,799 recordings from participants, 2737 of which were recorded during the documented exacerbations. Of them, 227 (147 sustained vowels and 80 read texts) were recorded during onset, peak, and recovery.

“We showed that exacerbation dynamics of asthma or COPD influence speech features, among others, pitch, shimmer, HNR, and duration,” the study authors wrote. “These features change as early as exacerbation onset and precede medication initiation in some participants.”

The study was exploratory and identified voice changes associated with, rather than predictive of, asthma and COPD exacerbations. Additional limitations included potential confounding from unmeasured inhaler use, lack of data on exacerbation causes, inclusion of only native Dutch speakers, and no adjustment for multiple statistical comparisons, limiting the generalizability and strength of the findings.

“Speech is simple, cheap, and quick to capture on participants’ own mobile devices in their home environment,” the study authors concluded. “Altogether, these results demonstrate the potential of home monitoring with voice as a putative biomarker in chronic respiratory diseases, potentially detecting exacerbations early, prompting the start of treatment earlier, and thus improving healthcare outcomes.”

References

1. Bemmel L, Reinders LG, Helvoort HAC, et al. Voice as biomarker for early exacerbation detection in asthma and COPD: the TACTICAS study. ERJ Open Res. 2026. doi:10.1183/23120541.01737-2025

2. Assess and monitor your asthma control. American Lung Association. June 2, 2026. Accessed July 15, 2026. https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/managing-asthma/asthma-control