Voice biomarkers may offer a new way to detect worsening asthma or chronic obstructive pulmonary disease (COPD) earlier, according to a study published in ERJ Open Research. The research suggests that changes in a patient’s voice — captured on a smartphone — could signal the start of a flare-up before symptoms become severe enough to require hospital care.
How the TACTICAS Study Tracked Voice Changes
The study, named TACTICAS (Telemonitoring for Asthma and COPD through voICe analysiS), enrolled 73 patients across two medical centers in the Netherlands.
Participants were recruited between January 2022 and May 2024 and had a confirmed diagnosis of asthma or COPD with no other conditions that might affect speech. The monitoring period lasted 12 weeks, with researchers checking in by phone every four weeks to document symptoms and medication changes.
Baseline lung function and medical history were pulled from electronic health records.
To capture exacerbations, they used the EXACT questionnaire — a 14‑item patient‑reported tool. An EXACT event was defined as a sustained increase of more than 9 points above baseline for at least three days, or more than 12 points for two days in a row.
Patients recorded their voices using a mobile app, performing three tasks: holding a sustained vowel “a,” reading a short text, and speaking spontaneously. In total the team collected 23,799 recordings, 2,737 of which happened during documented exacerbations.
Related: User Receives Unexpected Block Notification
Remote voice monitoring has been tried before for other chronic conditions, but applying it to respiratory disease poses unique challenges — background noise, medication timing, and the need for people to actually use the app consistently. The TACTICAS study kept the protocol simple: no special equipment, just a phone and a few minutes of speech.
Voice Features That Change at Exacerbation Onset
Of the 73 participants, 35 (48%) experienced at least one exacerbation during the 12‑week window.
It captured 38 total.
The EXACT questionnaire correctly flagged 30 of those (79%). The remaining eight were identified later through electronic health records and medication review.
Among the 2,737 flare-up‑period recordings, 227 were made during the onset, peak, and recovery phases — 147 of those were sustained vowels and 80 were read texts.
The authors reported that speech features such as pitch, shimmer, harmonics‑to‑noise ratio (HNR), and duration changed measurably as early as the onset of a flare-up, sometimes before patients started rescue medication.
Related: Users Blocked by Website Security Filter
“We showed that the progression of asthma or COPD exacerbations influences speech features, including pitch, shimmer, HNR, and duration,” they wrote. “These features change as early as the onset of a flare-up and precede medication initiation in some participants.”
The research was exploratory, meaning it identified voice changes associated with flare-ups rather than predicting them.
Limitations included the lack of adjustment for multiple statistical comparisons, possible confounding from unmeasured inhaler use, and that only native Dutch speakers were enrolled. Those factors limit how broadly the findings can be applied.
“Speech is simple, cheap, and quick to capture on participants’ own mobile devices in their home environment,” the researchers concluded. “Altogether, these results demonstrate the potential of home monitoring with voice as a putative biomarker in chronic respiratory diseases, potentially detecting flare-ups early, prompting the start of treatment earlier, and thus improving healthcare outcomes.”
Current self‑monitoring for the conditions relies heavily on patient‑reported symptoms and occasional clinic visits.
The American Lung Association offers a guide for tracking asthma control that includes symptom diaries and peak flow measurements. Voice‑based monitoring, if validated in larger studies, could give clinicians an automated early‑warning system that does not require patients to actively log their breathing.
