What If Your Cough Was Being Measured 24/7? With Dr. Peter Small

Do you cough a lot? 

Does someone you know cough a lot? 

What if you could actually measure it, continuously?  

For people with chronic cough, those question matters. 

Because right now, most of what we know about cough comes from self-report. And that’s not very precise.

In this episode, Dr. Eeks speaks with Dr. Peter Small from Hyfe, a company using AI to continuously detect and count coughs, turning a common but poorly measured symptom into something objective. Hyfe is the FIRST company to create a tool to continuously monitor coughing. 

Their technology processes sound in real time and records cough events without storing audio, allowing for long-term, privacy-preserving monitoring.

Hyfe is part of a growing field called acoustic epidemiology, which uses body sounds, like coughs, to better understand health and disease patterns.

We talk about:

• what a cough actually is, and how you define and quantify it
• how many people struggle with chronic cough
• what “continuous cough monitoring” looks like in real life
• bad coughs vs good coughs
• how Hyfe measures cough
• why measuring cough is useful for people who want to monitor their health more closely
• and whether cough monitoring and patterns could eventually be used for public health surveillance

We also discuss cough suppression therapy (CST), a behavioral treatment often delivered by speech-language pathologists, which has been shown to significantly reduce symptoms in many patients with chronic cough. Hyfe plans to offer it as a digital therapy folks can access from home. 

Dr. Peter Small is the Chief Medical Officer of Hyfe, where he focuses on using acoustic AI to improve human health. An infectious disease specialist, he has spent his career developing global health solutions, with a particular focus on tuberculosis. His work has spanned Stanford University, the Gates Foundation—where he led major TB initiatives—and global programs in India, Madagascar, and Nepal, using technology to expand access to care.  

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Transcript

SPEAKER_00 0:00

Welcome to the Causes or Cures Podcast, your gateway to understanding health and groundbreaking medical research in a fun and easy to understand way. With Dr. Eats as your host, join us as we sit down with the world's leading doctors and scientists to unravel the mysteries of health. From practical tips on well-being to the latest breakthroughs in medical research, we cover it all. Don't forget to subscribe. Now, let's ignite our curiosity and together dive into today's episode.

SPEAKER_02 0:31

Hello everybody, and welcome to this episode of Causes or Cures. I'm Dr. Eeks, your host, and hope you're all doing swell out there. So today we are talking about cough. Cough, coughing, a cough that won't stop. Maybe you're one of those people who coughs all the time, like a chronic resistant cough. If you've ever had a cough that just won't stop, you know how frustrating it is, right? It's hard to go to the movies, see a show, travel, because you're coughing all the time. But it's also hard to explain. People will ask you how bad it is, and you're like, I don't know. It's just constant. That's part of the problem. We don't really measure cough in any consistent way. And when you don't have objective measurements, guess what? It's hard to know what to do with something. In this episode, I talk with Dr. Peter Small. He's an infectious disease doctor from the company HIFE. They've developed the first tool for continuously monitoring cough, which you can use right from your phone, basically turning something subjective into something you can count and follow over time. Dr. Small also describes how it can be potentially used to monitor for outbreaks. Yeah, like another public health surveillance tool, which some of you might like and some of you might not like. We talk about how that works, what a cough even is, how many people are out there struggling with chronic cough, more than you know, bad coughs versus good coughs, and how measuring it actually helps people. We also get into something interesting called cough suppression therapy. So you'll hear him say CST. That's what it means. And that's something a lot of people haven't heard about, but can be really effective for chronic cough. All right. So if you've ever struggled with chronic cough, if you know someone who struggles, you can listen to this and help them out. Listen to it yourself and uh learn something. All right. So give me a few seconds here, gang, while we connect to Dr. Small. Everybody, we are connecting with Dr. Peter Small, and we're going to talk about chronic cough and a new intervention uh that they're working on. But first, Dr. Small, thanks so much for joining. Causes or Cures. And I thought maybe you could tell our listeners a little bit about yourself before we jump into today's topic.

SPEAKER_01 3:12

Yeah, uh I'm uh I'm a physician by training. Uh, I trained in infectious diseases, spent uh part of my time uh, well, I started my career at the dawn of the AIDS epidemic in San Francisco. I was a clinical investigator at Stanford for quite a while, and then I moved to Seattle where I built and ran the tuberculosis program for the Gates Foundation. And a common theme through all of that was uh tuberculosis and finding people who are coughing and getting them evaluated and when appropriately treated for TB. And in addition uh to uh to that, I'm also a chronic cougher. I I cough 40 to 80 times a day, and I have for the last three decades. So uh I'm excited to have joined HIFE about four years ago uh and really focused on improving the world's uh treatment of of that condition.

SPEAKER_02 4:10

All right, chronic cough. And we're gonna get into uh statistics around that, you know, and we kind of put some uh details to what that really means, but it's hyfe. I was saying, I wasn't sure how to pronounce it. It's hyfe H Y-F-E.

SPEAKER_01 4:24

That's correct. Yeah, it although if you're a native uh French speaker, you can pronounce it hyphi. We don't really care.

SPEAKER_02 4:31

Hai fe. I'm not French, but for some reason I was saying hyphi. Um, but hyfe. So it says so it's an AI company pioneering the field of acoustic epidemiology. So I was like, okay, you have to explain to our listeners what is acoustic epidemiology.

SPEAKER_01 4:50

Well, you know, uh acoustic epidemiology is the application of basic principles of understanding disease and its transmission uh to the richness of sound. And we've focused entirely on cough uh and using acoustic AI to recognize and timestamp coughs uh so that it can be used in in research and in patient care.

SPEAKER_02 5:22

And so you used you trained an AI model. So how did you do that? You know, because I'm just thinking of all the different coughs I've heard during my time on Earth.

SPEAKER_01 5:34

So yeah, you know, uh we the the amazing thing about cough is is how poorly it's quantified. And so our focus is really on objectively recognizing and measuring when people cough. Uh so what we've done is we've um developed two algorithms. One monitors sound level. Importantly, it's not listening, it's just monitoring the level of sound. And when there's an explosive sound, uh like a dog barking or person sneezing or coughing, we we grab a short snippet of sound and we run that then through a second algorithm, which is uh based uh on uh a convolution neural network that can recognize a cough and distinguish it from other sounds. It's not unlike the technology that Google uses to recognize faces in photographs. Uh so we didn't give it rules, we had just gave it tens of millions of examples of human annotated sounds as cough or not, and and it's now able to recognize coughs from other background sounds with extremely high precision uh and accuracy.

SPEAKER_02 6:52

Okay, and how are you guys quantifying a cough?

SPEAKER_01 6:58

Yeah, so we just we just timestamp the cough. It turns out that what's most revealing is uh how much people are coughing, what time of day they're coughing, whether they're coughing in long and painful bouts, or whether they're isolated coughs. So it's really the the quantification and the analysis of the pattern of coughs uh that's that's most uh reveals the most information is the focus of our work.

SPEAKER_02 7:27

Okay, okay. So like if they're coughing more at night, for example, if the frequency increases.

SPEAKER_01 7:34

Yeah, you know, as a as a medical school professor, I often told, you know, medical students that, you know, if you're coughing after a meal, it's probably reflux. If you're coughing at night when you lay down, it's it's probably postnasal drip. And and now we can actually measure cough and and see when a patient's coughing and and actually see whether any of those clinical pearls are actually true or not.

SPEAKER_02 7:57

Okay. So I also saw these words, continuous cough monitoring. And I, you know, I've been seeing that a lot lately, you know, coming up in medical articles. There's all like a seems like a trend now is continuous monitoring. I've you know, you've seen it with blood pressure, of course, glucose. So my question to you is what is the evidence for monitoring a cough continuously?

SPEAKER_01 8:22

Yeah, there's well, first of all, it was not possible do to do into until we came along. And and now we're bringing we are we are, and we and we're now bringing science to this. And so, you know, what we have shown is what's kind of known to all of us who do cough, that that people have good days and bad days. So that if you want to understand whether how much someone is coughing, either because you want to improve their cough, reduce their cough, or because you're developing drugs and you need an endpoint in a clinical trial, you really can't measure cough for a short period of time. You need to measure it continually. Uh, and by measuring it for say three to seven days, you get a really good sense of what their cough rate is that's far more accurate than a point estimate from you know an afternoon or even a full day.

SPEAKER_02 9:13

Well, let's talk about chronic cough or refractory cough. Uh you mentioned that you're a chronic cougher, and um I I feel free to share your personal story if you're comfortable, but I'm just curious, like how big is this uh issue? You know, you know, what's the scope of the problem basically?

SPEAKER_01 9:32

Yeah, well, um first of all, uh you know, cough is the world's most neglected symptom, right? It's it's it's the one of the most common reasons that patients seek health care. About 10% of the population have a protracted cough. And when that cough lasts longer than two months, it meets the medical criteria as a chronic cough. And and and for many uh chronic cougers, the etiology is either unexplained, or even if it is known, treatment of that underlying condition does not uh alleviate the cough. And so that's refractory chronic cough. So we have about seven million Americans who have unexplained or refractory chronic cough, and there are very limited treatment for cough in general. I mean, most of the over-the-counter remedies are largely placebos. The last time the FDA approved an antitussive was more than 60 years ago, and and there are no drugs that are specifically approved for unexplained or refractory chronic cough. Now, encouragingly, uh, there are new understandings of the biology of cough and molecules being developed, and some big programs. Merck had a had a big program. Uh right now, GSK is uh conducting a phase three trial on on what looks to be a great cough medicine. Um, but underlying this whole dynamic of neglect is is that cough is was unmeasurable. And you know, it's it's an old adage that what doesn't get measured doesn't get addressed. And you know, I myself went to see my doctor 30 years ago, probably, and and and I know what they do because then I became one of those doctors, you know, it probably they measured my weight, my temperature, they might have done a pulse oximetry, they might have even done for me. They they even did pulmonary function testing. Um, but they never measured my cough. And and in fact, you know, they just asked me, so how much are you coughing? And and and you know, the real answer is I don't know. I mean, nobody really knows how much they're coughing. I mean, how many times did you cough yesterday? And and and and and this ambiguity creates frustration for both patients and providers. So you know, one person say, Oh, I cough a lot, and that may be twice an hour for another person that could be far more. And you know, for example, I diagnosed myself with COVID a few years back, and I called my doc and she said, Oh, you know, I wanted some tax with her. And she said, You can't, you're not at high risk. I said, but I'm coughing. And she said, Well, everyone coughs. And I said, Yeah, but I'm a chronic cougher. She goes, Well, so what? You know, and I said, No, no, look here. I coughed 451 times yesterday. And she wrote the prescription. So, so what you know, hyfe was really founded to address this fundamental problem of measuring cough.

SPEAKER_02 12:52

Measuring cough. Okay. That that makes a lot of sense. And yeah, like I agree with you. And if I thought about how many times I coughed yesterday, I wouldn't be able to remember, um, or even like when I coughed more morning or night. But I wanted to ask you about the cough suppression treatment. So it sounds like part of hyfe is measuring cough. And then is there another part of it where you are doing this cough suppression treatment? Um, CST that's part of it. Okay, tell our listeners what that is.

SPEAKER_01 13:26

So um, you know, our core technology is basically a Fitbit for cough. And um, you know, it's either a watch or a wellness app. It's it provides accurate, passive, privacy-preserving monitoring of cough. It's being used in over 50 trials worldwide to better understand cough and also in as an endpoint in in FDA uh drug development trials, um, and we're being evaluated by the FDA as a medical device. But but we've we've moved into digital therapeutics because it's an extremely exciting way of delivering interventions. And and in particular, uh it's it's been a bit of an open secret that um uh if you uh uh well behavioral cough suppression therapy is a curriculum that's provided by uh uh speech pathologists, um, generally over four weekly visits. And um it it it is a way of addressing uh refractory and unexplained chronic cough. So, you know, the mechanism of of this cough, it's it's hypersensitivity to cough stimuli. It's it's it's akin to to chronic pain. Um and and and this hypersensitivity is it's it's it's dysfunctionally reinforced, you know. The more you cough, the more you feel the urge to cough. It's kind of like a mosquito bite, you know. You have a mosquito bite and you think, gosh, if I scratch that, it'll feel better. But it doesn't, it itches more, and and and the less you scratch it, the less it itches. And same with cough. And so behavioral cough suppression therapy um is this curriculum in which uh has two parts. Uh the first is this that the curriculum explains cough and what's a good cough and what's not. Um, and then the second is it it includes um techniques for cough suppression. And over time, patients working with a speech pathologist can reduce their urge to cough and their cough by by suppressing their cough when they feel feel the need. And um, you know, the big problem here, however, is that there are seven million Americans who have this condition and fewer than 200 speech pathologists who are trained to deliver it.

SPEAKER_02 16:06

Right. And okay, so just to um emphasize or repeat for our listeners, this is done in person by trained speech pathologists who do this, but there's a great need. Um, so you're kind of taking it to the digital realm to try to to try to reach more people with with an evidence-based protocol. I wanted to go back to something that you said. You said you teach people the difference between a good cough and a bad cough. What do you mean by that?

SPEAKER_01 16:34

Well, you know, cough is is a is an interesting phenomenon. If you were not coughing at all, you will probably die from aspiration pneumonia. And if you're coughing a lot, you may be in the process of dying from pneumonia. So so cough is important and it is a physiologic response. It's a way to keep the airways clear.

SPEAKER_02 16:56

Right.

SPEAKER_01 16:56

On the other hand, uh, in for many people, the cough is is not a functional response, but it's this neural hypersensitivity. And then it's just a problem, and it and it's more than just an annoyance. You know, those of us who have chronic cough, I mean, particularly in the post-COVID era, I can't, you know, when I'm having a bad coughing day, I can't go to the movies. And God forbid I should get a coughing spell when I'm on a plane. Um, and and and you know, some people they end up get cough so seriously that it breaks their ribs.

SPEAKER_02 17:30

Oh, geez.

SPEAKER_01 17:31

So so there are good coughs, but but there are a lot of people who have a dysfunctional cough, and and that's really what we're focused on alleviating.

SPEAKER_02 17:40

Okay, okay. And it interferes with their ability to kind of go about life and enjoy life, or maybe they have fear about like you go getting on a plane or something like that, which totally makes sense. You don't want to be the person coughing on a long flight. Um the the the one thing I wanted to ask you about uh this, I'm just more a little more curious about the CST. You said it usually is four weeks and it just it's so it's teaching a person kind of techniques how to suppress their cough, I guess, safely. And you know, the person would have to understand, I guess, why they're coughing. Um, I guess there's some some, you know, so it's for chronic cougers.

SPEAKER_01 18:21

Yes.

SPEAKER_02 18:22

Okay. Yeah.

SPEAKER_01 18:23

Yeah. So so once uh many conditions are excluded and you end up in this broad category of unexplained and refractory chronic cough, okay, and you have very few, no FDA drugs approved, this is where if the behavioral cough suppression therapy is is is applied. And and it's and it's it's been shown in 17 different studies to be highly effective. In fact, though the most the best study shows that it is as effective as the molecules that are in the the pharmaceutical pipeline.

SPEAKER_02 19:02

Okay, in the pharmaceutical pipeline, yeah. I recently had someone on my podcast, uh a researcher, talk about the over-the-counter cough medications. And I think my listeners were very surprised to realize how little evidence exists for their efficacy. Like they, you know, for some we all buy them, but um they they really, you know, people will say they work, and maybe that's why they keep buying them, but there's really no randomized controlled trials to show that they work.

SPEAKER_01 19:31

Um fucking, isn't it? It's not, I mean, not to those of us who cough, because it doesn't help me, but you know, it is it is amazing, yes.

SPEAKER_02 19:39

Yeah, well, they're just like there on the drug shelf and they make millions of dollars, and then you're like, okay, wait, there's no real evidence that these work. Like, what am I buying?

SPEAKER_01 19:48

Yes, and and and then and then on the flip side, here you have a non-pharmacologic intervention, yeah, which has no side effects, which is proven to be efficacious in in some of these uh conditions, and is only available through 200 practitioners.

SPEAKER_02 20:11

Right, right, in person. So you have this like an app. Is it okay to call this an app?

SPEAKER_01 20:17

Yeah.

SPEAKER_02 20:18

Okay, so the whole thing is an app. Now I want to go back to who would use this because you mentioned there's an exclusion process for the the folks who are gonna get the cough suppression treatment. Uh, but then I was reading on your website, you know, people who have coughs with underlying conditions like asthma, COPD, perhaps they have, you know, an infection in their lungs, COVID, cancer. You think about the types of conditions that you know that come with a cough, but also those folks may want to measure their cough. So I'm just curious, how do you foresee this kind of being used in practice?

SPEAKER_01 20:55

Yeah, so I'd separate two things here. One is the Hive cough monitoring technology, which I think has broad applicability. Uh, anyone who has a cough is able to use our wellness app to measure their cough. It's a freely available app that they can download. It's not a medical device, it's not meant for diagnosing and treating medical conditions, but it does give patients insights into how much they're coughing, what time of day, and the triggers so that they can have a more informed conversation with their healthcare providers. So that's the one arm, which is the monitoring. Uh, and the second, though, is the therapeutic, the the digital therapeutic, which is again not yet FDA approved, but which delivers through uh through the app the same curriculum that they would get were they fortunate enough to live near one of these 200 providers. And and so that Is effective in refractory and unexplained cough. And you know, so after seeing a doctor getting common and other conditions ruled out, then this would be an appropriate therapy for them.

SPEAKER_02 22:16

And so does this have to come from a like a clinician recommendation, or can anybody access it?

SPEAKER_01 22:24

So right now it's a it's a product that's in development. It is not FDA cleared, and so it's not um available as a treatment. Um we uh are super excited that we uh recently uh completed and announced the top line results of the trial in which we proved the concept that our technology actually works. It's uh you know just part of this this wave of of digital therapeutics. Uh but we have uh we presented at the chest conference uh just last month that our digitally delivered behavioral cough suppression therapy reduced cough frequency by more than 40 percent uh in patients who are suffering from refractory and chronic cough. And in 80% of the study participants experienced a clinically meaningful improvement in their in their quality of life. And you know, I think this is just one step towards uh expanding access to this proven therapy. Um, but obviously we still have a ways to go. We we need uh to to get through the regulatory, we we need to do a definitive trial and show that that these results are are are reproduced and and and then go through the regulatory process before it's a real uh widely available therapeutic. Okay, and just for our listeners, this was a proof of concept study, and I believe 10 people correct me if I yeah, it was a single arm 10 person proof proof of concept study that was uh conducted uh in in the US.

SPEAKER_02 24:05

In the US, okay. And so this is basic when we're talking about statistics and the 200 providers, you're basically talking about the US.

SPEAKER_01 24:12

That's correct.

SPEAKER_02 24:13

Okay, okay, just making sure. And to use this device, uh anybody with any device can use it? Or to I'm sorry, to use the app.

SPEAKER_01 24:25

Yeah, so so so the the monitoring app is is is available and and uh freely downloadable from either the uh iOS or Android uh app stores.

SPEAKER_02 24:37

And you just need a microphone.

SPEAKER_01 24:39

Well, yeah, it just runs right off the off the phone itself, yeah.

SPEAKER_02 24:42

Right. Okay. And you applied for FDA clearance.

SPEAKER_01 24:46

Yeah, so what we've also done is we've um we we put the same technology on a watch. Uh and that watch runs the algorithm in real time. It sends the timestamps of the coughs to a companion app. And then that information is available to patients and providers. And we've um we're pursuing FDA de novo clearance for this as a medical device. And once we have that, then it can be used as part of diagnosing and managing cough-related conditions.

unknown 25:26

Okay.

SPEAKER_01 25:27

And we're expecting that uh approval fingers crossed uh in the coming year.

SPEAKER_02 25:32

Oh, okay. Okay, so that's right around the corner. So you have folks who have chronic cough who may be using kind of like the measuring app now on their own, and anybody can use it if they want to learn more about their cough or monitor it. You mentioned you had researchers using it when cough, if they want cough to be kind of a measurable outcome in whatever trial they're doing, right? You mentioned okay, okay, that's interesting. And the other thing I thought which was interesting, because I've done I've worked, you know, an outbreak response. And so I saw where it could be used as public health surveillance or like disease outbreak detection. I thought that was a really interesting potential use for it. I was wondering if you could talk a little more about that. I mean, you're an infectious disease guy, so yeah.

SPEAKER_01 26:19

No, I think it's super exciting. I mean, the future of cough is uh we're we're at a real inflection point. Uh the suddenly the ability to measure cough. I mean, I'm an infectious disease doctor. I'm I'm I'm fond of of ribbing my pulmonology friends by saying, you know, 300 years ago, we invented a device to measure our patient's chief complaint and stop saying, How hot do you feel? But we measured their temperature. Now finally the pulmonologist can stop asking their patients how much they're coughing and actually measure their cough. And I think, you know, in the short term, in a few years, once our device is FDA cleared, it'll be like a blood pressure monitor. Anyone who has a cough-related condition will have a cough measuring device that they use as needed. And then I think over the coming years, it'll it'll evolve more into like step counting. It'll be a feature that's available on all sorts of consumer electronic devices, and people will just pay attention when they care. If they have a they catch a cold, they'll start measuring their cough and make sure it's going away rapidly enough and that it doesn't come back and indicate that they developed a pneumonia on top of their virus. And then I think what's going to happen in the long run is that uh that this sort of information will be widely available and can be collected in an anonymous way that makes for public health surveillance. And and in fact, we've conducted a study early in the COVID era where we loaded the the app on a bunch of phones in a community in Spain with the uh expectation that if we could could measure enough coughing, we'd be able, it would be an early indicator of a new wave of COVID. And and then that the study didn't work. We failed to get many enough people to use it for it to be an effective device. But I think that's where the future is going. It's uh it's that uh, you know, the vast majority of these pandemics are pulmonary respiratory conditions and have as a prominent manifestation of cough. So I think that this could be a real early indicator of uh of respirator conditions, which could be just another round of flu, or it could be something entirely new.

SPEAKER_02 28:39

You know, I that was one of the criticisms during COVID, you know, or people would say early intervention. And you I mean, you hear that with almost any infectious disease or anything really, right? Like early, it's early intervention is key. My question to you is um, how early, and given that you're infectious disease expert, you know, how early of a symptom is cough? I mean, and that could potentially that could make a significant difference if someone says, Oh gosh, I have cough. Yeah.

SPEAKER_01 29:08

Yeah. So it's it's interesting as as a physician, I spent a lot of time asking patients, like, so you know, now that you're taking your TV meds, is your cough getting better? Or, you know, someone who has COPD, it's like, oh, well, you know, is your cough getting worse? Uh and and oblivious to the fact that patients don't really know, and particularly you know, subtle changes over time. And and so there have been some really good studies that have shown that cough is an early indicator of deterioration in a lot of individuals. So, not just to use it at a population level for surveillance, but but but but but for individuals, so for COPD, for example, objectively objective increases in cough are seen three days before people present to the emergency room. And and and thus you it enables the early intervention that keeps them out of the emergency room, the intensification of treatment promptly that that prevents these exacerbations that are so problematic for individuals and costly to the healthcare system. So once our cough monitor is approved by the FDA, then we envision uh great great opportunities to improve the health of people with these chronic uh pulmonary conditions.

SPEAKER_02 30:36

Yeah, especially if you can do something for them without them having to um incur a huge cost, right? Because I think so many people in our country just hold off on going to the doctor, or they don't, you know, they just don't want to know. Oh, they're like, okay, let's wait it out, you know, see if it gets better on its own because of the cost, how much how much it costs, you know?

SPEAKER_01 30:58

So well, and this is this is part of that wave of empowering people to manage their own care better. And uh, you know, look, look, for me, when I have an exacerbation in my cough, often after a viral illness, I can take a bolus of steroids. I hate it, I don't sleep well, I get hypomanic, uh, you know, it's it's it's it's miserable. Yeah, so my inclination is to ignore the cough for a few days. And yet, if I don't take those steroids promptly, they don't have any real impact. And so, how do I know on day one or day two that my cough is significantly different than the past? And and this is another uh area in which we're making huge progress because we are deep into the statistics of cough. And and without going too far down that rabbit hole, I just to say that you know, there's no 120 over 80 in cough. I cough 40 to 80 times today. If I cough 60 times tomorrow, it's just another day. If you cough 60 times, you should probably see a doctor. And so we're able with monitoring cough to develop individual statistical models and and and notice and report back to the individual, hey, your your cough is is significantly worse today, or it's been worse now for two days or three days.

SPEAKER_02 32:18

Yeah.

SPEAKER_01 32:18

And and and now we're not, you know, we're not a medical device, we're not using that information to tell them what to do about it. We're just giving them the facts and letting them and their providers figure out whether that means they should be on intensified treatment or not.

SPEAKER_02 32:33

Yeah, no, no, and that's I think you know, just kind of creating that awareness is good. And then and then the next step could be more like precision medicine, right? Like when you can start using it and the FDA approves it and that kind of thing. Um I know.

SPEAKER_01 32:46

Isn't it ironic that in this era of precision health, the most common symptom is totally unmeasured?

SPEAKER_02 32:55

Yeah, it is. I mean, you don't think about it. I mean, I'm thinking about it because I'm doing this podcast, but yeah, you don't think about it. It's like, you know, how many times did you cough yesterday, or did you, you know, coughed most of yesterday, didn't cough at all? Like, you don't, I mean, I have no idea, you know. It's just uh, I think there's a lot of people in that boat.

SPEAKER_01 33:13

We we don't think about it as patients, and uh pharmaceutical companies don't think about it as a condition. So, you know, a patient comes in to see me with asthma, and they're like, Yeah, hey, I'm like, hey, how's your asthma? And they're like, Well, I'm doing okay, but I'm I'm coughing a lot. And I'm like, Well, let's check your PFTs. You know, it's like someone comes in with interstitial pulmonary fibrosis. You're like, Well, you know, hey, how are you doing? It's like, well, I'm coughing a lot. Oh, really? Well, it looks like to me like your PFTs are still normal, you know, and and and so you know, because we haven't measured it, the the health system has ignored it. And and thus, you know, you see the end point in these clinical trials being pulmonary function tests and and not what's bothering the patients.

SPEAKER_02 34:02

Right, right, yeah. And I can imagine, like, if you have to cough all the time, that is just annoying for sure.

SPEAKER_01 34:08

Um, I'll tell you, you know, we uh, you know, we've our app has been downloaded over a hundred thousand times. And so we've had a lot of interactions with chronic cougers, and uh the stories that we have heard are are are just uh they're heartbreaking. And and and and I mean, there are people who cough 1200 times a day. I mean, wow, imagine. I I I'll on a bad day I'll cough 500 times a day, and uh it's exhausting. I'll tell you by by 3 p.m. I'm ready to bite anyone's head off who comes close to me. It's just exhausting and frustrating. And whereas for for for many older women, you know, every it's not how many times they cough, but when they have a bout of coughing, they'll they'll have urinary incontinence. Cough incontinence is very common, super, super problematic for these women.

SPEAKER_02 34:59

Oh, yeah, that's true. That's like a whole market out there for that, for sure. So have you tried, I'm curious. This um therapy, I mean, other people on your app have tried it, or no, it's not available yet.

SPEAKER_01 35:11

Yes, it's um it's not an FDA cleared therapeutic at this point in time.

SPEAKER_02 35:16

Okay, so you can't use it? Like I can't download the app and try the like behavior therapy. Is that what you're saying?

SPEAKER_01 35:23

So so there is a there is a module on um the downloadable app uh which allows which which gives this feedback and this education and which uh we think will be helpful, uh, but it is just to be clear, it is not a treatment yet. But I would encourage people to download the app and do these modules because at this point it's it's it's a it's a wellness app which is just providing education and feedback about this uh condition and so they can live a healthier life.

SPEAKER_02 35:58

Right, right, right. Now I no, and I appreciate that. I know you have to be real careful about the language and that kind of thing. Um, but I just wanted to know if it was available. And the type of, I'm just curious, like the types of feedback when people do use this therapy. Do you know, or maybe you used to tried it too? Um, if you're sensitized to having a chronic cough, like is it good? Is the feedback good?

SPEAKER_01 36:21

Well, two things. I will say objectively quantifying people's cough is life-changing for many of our users. They they they they they will email us and they'll say, Oh my god, I I I showed this to my doctor and he saw I was coughing 400 times a day. He finally took me seriously and we're working on it. You know, it's it's it's it's so validating for people who you know have serious chronic coughs, uh to be able to show and share their experience quantitatively. The um behavioral cough suppression therapy. I mean, we work uh with some of the world experts in this, and and and and the speech pathologists uh have um have fantastic experiences and patients love their the improvement, and and we're starting to see that same phenomena and the same effectiveness when we deliver it digitally.

SPEAKER_02 37:22

Okay, yeah. Um, and privacy, I'm just curious because I feel like if you're coughing, that can be like, you know, your voice can be recognized. How do you, you know, prevent somebody's medical information or health information from getting out there?

SPEAKER_01 37:39

Yeah, so our technology, I mean, one of the great things about it uh is that it is fully privacy preserving. So the device only records the timestamps of the cost. So there's no recording of ambient sounds or voices or anything else.

SPEAKER_02 38:00

And what are you doing next in terms of research? I mean, I saw you know, so you have the proof of concept study they presented at the chest conference. Uh, are you doing like a randomized controlled trial?

SPEAKER_01 38:12

Yes. Uh our next step is to to conduct uh a FDA enabling study, uh definitive trial, uh, and we'll be starting that next year.

SPEAKER_02 38:24

Oh, nice. Okay. So that will be if if you go if you're I guess you'll recruit for that on your webpage. Because I mean there might be folks just interested in joining a trial like that.

SPEAKER_01 38:34

Yes, absolutely. Yeah.

SPEAKER_02 38:36

And what what does the name HIF mean?

SPEAKER_01 38:39

Haif, uh it means nothing in any language. It's a four-letter word that that uh that was uh selected um largely uh well there was a time where we thought our business would be monitoring cough and becoming kind of the ways for cough. Sort of when we first started, we thought, like, oh, we'll have cough monitors everywhere, and this way you'll be able to, you know, know that at Pete's Coffee there's less coughing than over at Starbucks, and you'll go there rather than there. And so we sort of had this kind of hive mentality, and we thought, but all of that quickly uh went by the wayside when we really found that that that what uh was make a difference is is is monitoring cough for individuals and and then treating them with these new digital therapeutics, which I just think digital solutions are one of the most exciting frontiers in medicine right now.

SPEAKER_02 39:36

Yeah. Yeah, no, I I agree. Um I did some work for a digital company. Um, they digitize cognitive behavioral therapy for you know obesity, fear or anxiety, um, uh all sorts of phobia, there are all sorts of things. But sometimes for like the wearables and stuff like that, now there's so much stuff out there that you wonder like how accurate is this really, right? And sometimes I'll hear someone, okay, I bought like my mom just bought my dad a watch, and I'm like, well, which brand mom, like you know, is does it work? I bought something off of Amazon and it was like a piece of crap.

SPEAKER_01 40:14

Yes, yeah.

SPEAKER_02 40:15

So it's just I think that's a consumer problem though, today, you know, like, yeah, wearables are a thing, but it's like, does mine work?

SPEAKER_01 40:24

Yeah, yeah. Well, you know, this is like what I'm really proud to work for a company that has from the start been science first. And uh, you know, we've done the the the the definitive trials and and and we know that as people wear our watch and go around through their activities daily living, we pick up 90% of their costs accurately with only one or two false positives each hour. And so I I totally agree with you. And I think that's one reason why we are you know kind of going slow and going through the FDA process to to be you know the stamp of approval, it's it's laborious, it's painful in in many, many ways. But at the end of the day, people will know that that this is an accurate device that is safe and effective to use. And yeah, and and you know, and then and then where monitoring turns into a digital therapy is is is just so interesting. Um, you know, you've worked in in this field, you know that doctors are generally limited to prescribing drugs even when behavioral change is what's necessary. And and with these digital therapeutics, you can digitally deliver behavioral change. I mean, these are science-based, empirically proven, digitally delivered solutions. And and and and and they're teaching us a lot about neuroplasticity and and how changing behaviors actually rewires our brains, you know, without drugs and their side effects. So so I I I agree with you that that we need to be sure to have credibility and evidence, but my my excitement about the future is somewhat unbounded.

SPEAKER_02 42:17

So that's pretty cool. How does it feel to be like part of this company, like the first company to measure cough? Is that fair to say? I want to make sure I'm accurate.

SPEAKER_01 42:26

Yeah, I think that's accurate to say. We're the first uh company that then enables continuous privacy-preserving passive cough monitoring, um, and to do so, you know, at scale, uh, either with an app or with a specific uh wearable device. It's fantastic. You know, I I've had a charmed life. I I was involved in uh controlling TB when it was out of control at the start of the AIDS epidemic. I I was blessed to work at the Gates Foundation and you know, have the world's richest couple at the time, you know, provide unrestricted resources to take on the world's biggest problems. And and those were amazing chapters in my life. But I find that this is the in many ways the most exciting, that a small group of people can take on a problem and in this startup culture create a solution um and find where its niche is for improving health and and now pushing it into uh wide-scale availability. It's uh it's been enormously gratifying.

SPEAKER_02 43:41

And I mean, I think something like this can be cost effective too, and you know, leveraged in different areas of the world. Um, I think, you know, I guess the internet access is not great in certain areas, um, better than others. But do you fear at all that like the where Culture as it takes off, as continuous monitoring takes off, do you think we're gonna see like more health anxiety?

SPEAKER_01 44:06

That's an interesting question. Um, I will tell you, having practiced clinical medicine, is that there is a significant group of people who are anxious about their health. Ironically, not often those who should you know, I I I think that the technology has the potential to either enhance that or perhaps alleviate that. And I think that that bringing uh individual data to people in real time can be very uh very calming. So, you know, you can you can be concerned that COVID's out there and that you're gonna get sick, but if you can see that you're not, uh I think that could be calming to some people. But I'm sure it's it's all you know, it's technology doesn't solve fundamental problems. And I think uh anxiety about uh one's health is is is a serious issue for a lot of people.

SPEAKER_02 45:09

And I think we we kind of saw that a little bit with COVID too. Like that I think we created like a certain level of anxiety in people where they, you know, some people just like kind of ceased going out or just became overly worried to an unnecessary point because obviously to be alive is to have risk and that kind of thing. And I think about that just as like a public health communicator and you know, the messages we sent. And then sometimes I run into people and I'm like, oh man, is that appropriate level of response? Or did we kind of take it too far and now made this person completely afraid to like go out of their house without a mask or something? You know, I don't know, just things you think about.

SPEAKER_01 45:53

Yeah, absolutely. And and and you know, I think with your background, you probably have a sophisticated understanding of it. And and and and yet at the same time, I do feel that you know, bringing individualized data to individuals in real time um can allow you to scale a public health message with some more nuance.

SPEAKER_02 46:16

Yeah, and that's I 100% agree that we need more nuance, if if anything, just given, especially given America, because there is a lot of different uh viewpoints and belief systems and opinions in America. So I'm all for that if we can leverage precision public health, not just precision medicine. So that would be uh to me a great goal.

SPEAKER_01 46:38

Yes, yeah, I I love that phrase, uh precision public health.

SPEAKER_02 46:43

Yeah, because everyone's saying precision medicine, I'm like, man, after all this, the fighting and everything, like we need precision public health to um, or at least move in that direction, show people that we are moving in that direction. So Dr. Samal, thank you for your time. So if folks want to check out the app or download it for the information or just start measuring their own cough, like where do they go? What do they do?

SPEAKER_01 47:07

So the easiest thing is to just uh go to our website. Um, you can get there just by googling hyphyf e. Or if you just search cough and cough monitoring, you'll you'll you'll quickly get to us.

SPEAKER_02 47:20

Okay. Is it in the app store?

SPEAKER_01 47:22

Like the and and the yes, the the the it's cough pro is available in either the the Google or um the Apple Play stores.

SPEAKER_02 47:34

Oh, it's called Cough Pro.

unknown 47:36

Cough Pro.

SPEAKER_02 47:36

Okay, and then all just for our listeners, if they want to try, I'll put the website in the show notes so they can um get there easily. But thanks for your time. It's very interesting. Um all right.

SPEAKER_01 47:47

Well, thank you. And uh and I and thanks for you know focusing on some of these non-pharmacological solutions, because I I just think you know, we're there's this wave going now with these drug-free therapies, no pills, no side effects, and you know, this kind of giving us this deeper understanding of how our mind impacts our health and how neuroplasticity rewires that and this powerful potential of of digital therapeutics and thanks thanks for covering that.

SPEAKER_02 48:17

No, and I mean, on a personal, I have I was diagnosed with asthma after some virus that I had in my 20s. It was like I so I was like, you know, long whatever before, you know, long COVID started getting attention. But uh I know there's a psychological component to it because sometimes if I'm out running, you know, in the streets of New York City and something captures in the back of my throat and I'll feel a response, and then you get nervous because you know you have asthma, and then you might cough, but you're like the psychological component can make it a lot worse. So I totally personally understand like having a cognitive component and just knowing what to do. Okay, this is what this is, and this is what this isn't, and you can kind of get yourself into a better situation. So, but but I still run with my rescue inhaler just in case.

SPEAKER_01 49:04

There you go. All right, well, it's been great talking with you. Thanks so much.

SPEAKER_02 49:09

Enjoy the rest of your day there.

SPEAKER_01 49:10

Take care.

SPEAKER_02 49:11

Thank you. All right, guys. Thank you for joining in for this episode. It's interesting, right? A way to finally monitor cough continuously. One of the basic symptoms of health. And we're just addressing this now in a real way. Uh, you can find a link to hyfe in the show notes. I still want to say hyfe, but I guess it's hyfe. Um, also don't forget to sign up for my newsletter. The link for that is also in the show notes. And if you can leave a reading on Apple, Apple Podcast, this is a really specific request, please do. I really appreciate it. And it helps the podcast grow. Um, if you like it, if you don't, then you know you don't have to leave a review, right? Um, all right, and now it's time for the closing quote. This is a proverb. Some attribute it to George Herbert. Ebert, Ebert, Herbert, Sherbert. I think it rhymes with Sherbert. Um, oh, I love this quote. Here it is, ready. Love and a cough cannot be concealed. Love and a cough cannot be concealed. Oh, that's a good one. All right, that's it for today. I hope you have a great day wherever you are in this crazy, good, cool world of ours, and goodbye for now.