Model-Based Estimation of Respiratory Parameters from Capnography, With Application to Diagnosing Obstructive Lung Disease

• Published in: IEEE transactions on biomedical engineering 2017-12, Vol.64 (12), p.2957-2967
• Main Authors: Abid, Abubakar, Mieloszyk, Rebecca J., Verghese, George C., Krauss, Baruch S., Heldt, Thomas
• Format: Article
• Language: English
• Subjects: Alveoli; Asthma; Capnography; Carbon dioxide; Chronic obstructive pulmonary disease; chronic obstructive pulmonary disease (COPD); Confidence intervals; Data processing; dead space; Differential equations; Discriminant analysis; Diseases; Exhalation; Lung diseases; Lungs; Mathematical models; Medical diagnosis; Methacholine; Noninvasive treatment; Obstructive lung disease; Parameter estimation; Partial pressure; Patients; respiratory model; Time constant
• ISSN: 0018-9294; 1558-2531
• DOI: 10.1109/TBME.2017.2699972

Objective: We use a single-alveolar-compartment model to describe the partial pressure of carbon dioxide in exhaled breath, as recorded in time-based capnography. Respiratory parameters are estimated using this model, and then related to the clinical status of patients with obstructive lung disease. Methods: Given appropriate assumptions, we derive an analytical solution of the model, describing the exhalation segment of the capnogram. This solution is parametrized by alveolar CO 2 concentration, dead-space fraction, and the time constant associated with exhalation. These quantities are estimated from individual capnogram data on a breath-by-breath basis. The model is applied to analyzing datasets from normal (n = 24) and chronic obstructive pulmonary disease (COPD) (n = 22) subjects, as well as from patients undergoing methacholine challenge testing for asthma (n = 22). Results: A classifier based on linear discriminant analysis in logarithmic coordinates, using estimated dead-space fraction and exhalation time constant as features, and trained on data from five normal and five COPD subjects, yielded an area under the receiver operating characteristic curve (AUC) of 0.99 in classifying the remaining 36 subjects as normal or COPD. Bootstrapping with 50 replicas yielded a 95% confidence interval of AUCs from 0.96 to 1.00. For patients undergoing methacholine challenge testing, qualitatively meaningful trends were observed in the parameter variations over the course of the test. Significance: A simple mechanistic model allows estimation of underlying respiratory parameters from the capnogram, and may be applied to diagnosis and monitoring of chronic and reversible obstructive lung disease.