COPD exacerbations can be predicted with a smartwatch

People with COPD (chronic obstructive pulmonary disease) never know when to expect a flare-up, which can lead to difficulty breathing, hospitalization or, even worse, serious complications – according to statistics from the World Health Organization, COPD is the third leading cause of death worldwide

A flare-up can develop for weeks and go unnoticed.

Tel Aviv-based RespirAI has developed an artificial intelligence (AI) algorithm that uses data from sensors in smartwatches and other wearable devices to monitor patients with chronic diseases.

This technology compares oxygen saturation levels (SpO2) and ECG results with the user’s physical movement to predict when a health condition is about to deteriorate, alerting the patient and doctor so that preventive action can be taken.

“We wanted to address an unmet need,” Nimrod Bin-Nun, CEO of RespirAI, tells ISRAEL21c. “There were tools for monitoring heart problems and diabetes at home. But for lung problems like COPD, we couldn’t find anything.”

“About 10% of COPD patients die while in hospital. The two-year mortality rate after hospitalization is a staggering 50%.”

This is significant because COPD is estimated to affect about 300 million people worldwide; one recent study predicts that by 2050, the global prevalence of COPD could approach 600 million cases.

Bin-Nun explains that the company wanted to bypass traditional approaches, such as detecting biomarkers in the blood or requiring a patient to exhale into a spirometer in a doctor’s office or undergo an MRI or CT scan.

RespirAI is currently undergoing clinical trials in Israel and plans to launch its product in early 2026.

Smoker’s disease

Chronic obstructive pulmonary disease (COPD) is characterized by inflammation and obstruction of the airways. The disease is not genetic. It is commonly known as emphysema or “smoker’s disease” because it affects about 20% of current and former smokers, although you can get COPD even if you have never smoked.

COPD patients typically experience difficulty breathing, a persistent cough, and fatigue. Exacerbations of the disease can occur several times a year, causing about 700,000 hospitalizations per year in the U.S.

COPD exacerbations account for about 4% of all hospital stays—the fourth leading cause of hospitalization. The direct cost to hospitals is more than $20 billion annually.

Worse still, about 10% of COPD patients die while in hospital. The two-year mortality rate after hospitalization is a staggering 50%.

There is no test that can provide an accurate assessment of the disease status or reliably predict when it will worsen.

To remedy this situation, Bin-Nun founded RespirAI in 2020 together with Assaf Gur, Vice President of Research and Development.

Both men have experience in medical technology: Gur has held executive positions at several medical device companies, while Bin-Nun has worked in business development at global pharmaceutical and medical device companies, including Teva and BioLight Life Sciences.

Always working in the background

The key to RespirAI’s AI is synchronization – checking that breathing and movement are in sync, and comparing a patient’s current symptoms to their baseline.

“Combined with artificial intelligence, this enables early detection of COPD exacerbations and worsening,” Bin-Nun says.

RespirAI uses sensors already built into nearly all wearable devices. Its algorithms monitor COPD status in the background, so all the patient has to do is wear the device.

Most wearable technology companies — such as Apple, Garmin and Samsung — “have gotten regulatory approval for these amazing sensors,” Bin-Nun says.

“Now they have to figure out what to do with them. They’re not health care companies. So they’re looking to technologies like ours to provide software to translate hardware results into more actionable outcomes.”

COPD patients typically see a pulmonologist every few months, but, says Bin-Nun, “it’s usually at the wrong time, when the patient doesn’t need to see a doctor, or when it’s too late, after they’ve been discharged from the hospital after a flare-up.”

If RespirAI detects worsening COPD symptoms at an early stage, medications such as steroids can stop the problem at the bronchial stage.

From Nebraska to Israel

RespirAI technology, unlike the typical way of founding startups in Israel, where R&D takes place in the Holy Land and marketing abroad, was not invented in Israel, but at the University of Nebraska in Omaha.

Bin-Nun says he and Gur were looking for a solution to chronic respiratory conditions like COPD when they learned about Nebraska’s algorithm. RespirAI then received an exclusive license from the university. They have five employees.

All of the R&D and testing was done in Israel. Some of that testing was supposed to take place in the southwest, where Hamas attacked on October 7. That, and the redeployment of some of the test workers and doctors, affected the company’s schedule.

The war with Hamas in Gaza has also limited foreign investment, but the company has received support and funding from the Israel Innovation Authority (IIA) and has raised $2 million so far. Its main backer is venture capital firm eHealth Ventures, which also runs an incubator in which RespirAI participated.

“Breathing should never be a luxury, and thanks to companies like RespirAI, it is becoming a reality,” eHealth Ventures wrote on LinkedIn.

RespirAI intends to be the first on the market to introduce pulmonary clinics.

The company has signed an agreement with Mayo Clinic to jointly develop a COPD monitoring platform. Clinical trials are also underway at Mayo Clinic, focusing on COPD patients who received the Zephyr valve as part of their treatment.

“This will lead to better patient outcomes, reduced healthcare costs and improved quality of life for millions of people suffering from respiratory diseases,” Bin-Nun explains.

More information here.