Q&A with Dr. Marc Judson

February 25, 2024

Dr. Judson is the Chief of the Division of Pulmonary and Critical Care Medicine at Albany Medical College. He is a global authority in sarcoidosis, having published more than 200 articles in this field.

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Please tell us a bit about yourself: How did you end up being interested in the measurement of cough?

I am a Professor of Medicine and Chief of the Division of Pulmonary and Critical Care Medicine at Albany Medical College in Albany, New York USA. I have had a career-long interest in the clinical aspects of sarcoidosis. In taking care of sarcoidosis patients, I noticed the sensitivity of the symptom of cough for active pulmonary exacerbations of sarcoidosis (APES). Although cough in sarcoidosis patients can have numerous causes (e.g., bronchitis, pheumia) and therefore is not specific for active disease, the absence of cough makes the possibility of active sarcoidosis quite unlikely. I formally studied this in analysis of 36 consecutive cases of APES, and 90% of them presented cough. This got me intrigued about the usefulness of monitoring cough to evaluate if treatment for pulmonary sarcoidosis was adequate.

What is your current research about? What is the aim of the trial?

Our current research involves using the Hyfe CoughMonitor to monitor pulmonary sarcoidosis patients who are experiencing APES. The patient must refrain from using any therapy to treat their APES for 3 days while we monitor their cough as a baseline measurement during an exacerbation. Then we initiate treatment for APES and observe the time course for the improvement in cough in relation to improvement in other parameters (pulmonary function, quality of life) from treatment of APES.

Do you have any hypothesis?

Our hypothesis is that cough quickly improves in patients with APES following treatment. This is not an obvious finding because sarcoidosis is a granulomatous disease, so one would expect it would take quite a few weeks for the granulomas inflammation of pulmonary sarcoidosis to be alleviated. Nonetheless, it has been my clinical experience that these patients’ symptoms, particularly cough, which is the most common and often the most disabling symptom of active pulmonary sarcoidosis, respond extremely quickly to therapy. This suggests that there may be specific non-granulomatous mechanisms for cough and other respiratory symptoms in active pulmonary sarcoidosis.

Which patients is this important for, and why does it matter to them?

I believe this research is impactful for pulmonary sarcoidosis patients because cough is a major distressing symptom associated with this disease. Improving our understanding of the mechanism and treatment of cough in pulmonary sarcoidosis would be very useful for these patients.

Have you seen any interesting results so far?

We have not formally analyzed our data yet. However, in eyeballing the results, it does appear that cough does improve extremely quickly with treatment of APES - more quickly than is traditionally anticipated.

Do you have any other hypotheses that you would like to investigate or that you wish others would investigate?

This is a preliminary pilot study, as we are only planning to examine 5 patients with APES. In this regard, this study is hypothesis-generating. We hope to perform a more rigorous trial that is adequately powered in a larger group of patients with APES.

What are you most excited about in cough science in 2024?

I think that state-of-the-art cough monitoring reflects the major innovations in medical care occurring in this century. We now have the technology available to easily monitor patient symptoms in real time. In the case of pulmonary sarcoidosis, although monitoring can be done by chest, imaging and pulmonary function, the monitoring of cough can occur minute by minute and be observed by healthcare providers.

Pulmonary sarcoidosis patients often require toxic medication to control their disease. It seems absurd in this day and age for us to assess patients every three months when they are receiving medications that could probably be reduced in a week or two if there was adequate monitoring outside of the formal clinic setting. In addition, if a pulmonary sarcoidosis patient develops worsening cough, suggesting reactivation of pulmonary sarcoidosis, a health care provider could contact the patient to determine the cause of the cough while the patient is outside the clinic.

In short, the application of cough monitoring in sarcoidosis will allow for an earlier reduction in toxic medications as well as earlier evaluation of pulmonary sarcoidosis exacerbations and the development of other pulmonary conditions. I don’t see why a similar treatment paradigm couldn’t be developed for other more common respiratory diseases, such as asthma, another pulmonary disorder where cough is a sensitive indicator of active disease.

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