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Cloud-Assisted IoT-Based Smart Respiratory Monitoring System for Asthma

Patients

Chapter · January 2019

DOI: 10.1007/978-3-319-96139-2_8

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Cloud-Assisted IoT-Based Smart
Respiratory Monitoring System
for Asthma Patients

Syed Tauhid Ullah Shah, Faizan Badshah, Faheem Dad, Nouman Amin,
and Mian Ahmad Jan

1 Introduction

The weight of the conventional healthcare system is becoming substantial because

of the increasing number of aging people combined with the small amount of
healthcare resources and personnel (doctors, hospital administrators, nurses). In the
healthcare industry, the use of communication apps, things (sensors and devices)
for healthcare monitoring are increasing exponentially and have a huge impact on
the patients and healthcare professionals. According to Forbes and Gartner, it is
estimated that by 2020, approximately 20 billion smart devices will be connected to
the Internet [1], while HealthcareIoT market will contribute to $117 billion with an
annual increasing rate of 38% during the 6-year period from 2016 to 2022 [2, 3].
According to these assessments, it is predicted that HealthcareIoT can play a central
role in the healthcare industry. IoT has a significant effect on the healthcare industry,
and various technologies, tools, and devices are used for different types of patients
(e.g., temperature, pulse, and oxygen in the blood, blood pressure, glucose monitor,
GSR, and ECG) to minimize avoidable deaths.
Presently, HealthcareIoT is in its early phases with respect to deployment, design,
and development. Nevertheless, IoT-based emerging technologies are providing
a significant influence, and soon many healthcare monitoring technologies will
emerge. By minimizing preventable deaths that happen due to hospital errors,
HealthcareIoT has the potential to save more than 50,000 patients in the United
States every year [4]. It guarantees patient safety and welfare by collecting and
monitoring patient health information with related support resources (wearable
smart devices to collect data and facilities for healthcare staff). HealthcareIoT can

S. T. U. Shah · F. Badshah · F. Dad · N. Amin · M. A. Jan ()

Department of Computer Science, Abdul Wali Khan University Mardan, Mardan, KPK, Pakistan
e-mail: mianjan@awkum.edu.pk

© Springer Nature Switzerland AG 2019 77

F. Khan et al. (eds.), Applications of Intelligent Technologies in Healthcare,
EAI/Springer Innovations in Communication and Computing,
https://doi.org/10.1007/978-3-319-96139-2_8
78 S. T. U. Shah et al.

Network
providers

Research
Emergency aid
institution
services

Network Recourses Decryption

Analysis Storage
Processing servers

Patient with Dispensary and

sensor and drug
devices manufacturer

HealthCare Family,friends
advisor and social media

Fig. 1 Conceptual design of the proposed HealthcareIoT system

result in access to better healthcare, minimized cost, and direct interaction between
healthcare professionals and the patient (Fig. 1).
Asthma is a prolonged lung disease of wheezing and breathlessness that occurs
several times a day or in a week in individuals. This disease is common among
children, and the number of deaths in children is greater than those in the elders.
According to WHO, more than 235 million people are suffering from asthma [5].
This disease occurs in both low-income and high-income countries, while more than
80% of deaths occur in low-income countries. According to estimates released in
2016 by WHO, over 383,000 deaths occur because of asthma in 2015. Air pollution
and smoking are the core causes for the problem. Due to the absence of instant
help, elder people suffer most and may experience stress. Still, no widespread work
has been done about cloud-assisted HealthcareIoT-driven framework for asthma
patients.
In this paper, we proposed a cloud-assisted IoT-driven healthcare monitoring
framework for asthma patients. First of all, using different devices and sensor,
patient respiration rate can be recorded at home or outdoors. On the client side,
using a desktop based or mobile application will take out the undesirable noise
from the collected signal. As patient data safety is very important in HealthcareIoT.
Therefore, data must be protected from unauthorized access. A gap in the patient
data security may cause mental disorder, social embarrassment, heart attack, or any
other physical damage. Therefore the signal is embedded with watermarking for
Cloud-Assisted IoT-Based Smart Respiratory Monitoring System for Asthma Patients 79

authentication and security. Respiration rate is calculated with the help of a simple
algorithm. After that the encrypted signal is transmitted to the cloud, where features
are extracted and classified with the help of a classifier. Then the classified data
with watermarked signal is transmitted to the specific healthcare professional. The
healthcare professional analyzes the signal and classified data and sends a decision
to the cloud server. At the end, the patient is notified with the healthcare professional
decision.

2 Literature Review

The IoT is an emerging technology of interconnected devices and sensors. These

devices and sensor can capture, store, transmit, and share that data for classification
and analysis. Many innovative IoT applications emerge in the decade [6–18]. But the
most promising application between them is healthcare monitoring. HealthcareIoT
consists of collecting patient data through different devices and sensors, analyzing,
and transmitting them by using a network to healthcare advisors for immediate care
[6–8, 12, 13, 15].
Respiratory rate is one of the important physiological aspects to be monitored
to obtain patient health information in critical condition. It is an important sign
to predict illness, a rapid refuse in patient health. In [16] the authors proposed
web-based gateways for IoT eHealthcare monitoring with both wireless and wired-
based services. The wired gateways are used in a small building or room to make
the system low cost and power efficient; movement inside the building or room
is restricted. In [17, 18] radio-frequency identification (RFID)-based healthcare
monitoring solutions were proposed. In [18] an IoT-based framework was proposed
to monitor patient data by using UHF-RFID technology. In [17] author proposed a
health monitoring system using RFID to capture patient humidity and temperature
information and send them to the cloud for further analysis and understanding. In
[19] an asthma monitoring scheme was developed using vital signs and IoT. In [6]
authors investigated various challenges and prospects exist in IoT for management
and health monitoring. In [7] using cloud computing, mobile computing, and web
services, the authors developed a remote patient monitoring system.
In [14] a secure data collection and transmission, mobile-based healthcare
architecture was introduced. Secure patient information is collected with the cryp-
tography, private, and secret keys. The data is securely transmitted with authentic
user access by using attribute-based encryption scheme. The core disadvantage
of this scheme is the computation time. In [19] a web-enabled IoT-based patient
respiration data collection scheme was introduced using vital sign. The main
problem with this approach is secure communication.
Till now, no secure comprehensive work was found in cloud-assisted IoT-based
healthcare monitoring for asthma patients. Where the respiration signal is collected
using sensors, the collected signal is enhanced and watermarked before transmitting
to the cloud server using the Internet. At the cloud end, features are extracted after
decryption and signal restoration, where the healthcare professional analyzes patient
condition and provides immediate care.
80 S. T. U. Shah et al.

3 Proposed Cloud-Assisted IoT-Based Health Monitoring

System

IoT-based healthcare monitoring can play a very important role in modern-day

patient care by adapting a wide range of interconnected sensors and devices;
cloud technology and big data are used to collect, record, and monitor patient
data. The integration of these technologies can form a smart healthcare patient
monitoring system. The proposed scheme can transfer patient information among
the different participants in a secure manner, where it is only available to the
authorized healthcare monitoring team. At the cloud side, it supports to analyze,
store, monitor, and securely transmit the patient data for medical recommendations
and additional evaluation to minimize hospital errors and provide quality healthcare.
Figure 2 illustrates the IoT-based health monitoring scheme for asthma patients.
First, patient respiration data are collected using a sensor, and then after signal
restoration, enhancement, and watermarking (encryption), it is transmitted using a
network connection to the cloud server.

Fig. 2 The proposed scheme for patient respiration monitoring

Cloud-Assisted IoT-Based Smart Respiratory Monitoring System for Asthma Patients 81

The key components of the proposed scheme are described as follows.

Respiration Signal Collection Service This service is used to capture and store
patient respiration signal from various sensors and devices.
Healthcare Advisor and Other Support Services Patient respiration signal is
uploaded to the cloud server, where it is stored in the cloud database, so healthcare
advisors can access and analyze that signal for possible action and medication.
Recourse Allocation Management This phase is responsible for allocation of
physical resources and regulating VMs. It also provides authorized data access to
the patient information and decides whether to share the information or not.
Secure Signal Transmission Service This service allows secure transmission of
the record respiration signal. This can be achieved by applying watermarking to the
recorded signal.
Cloud Manager This service manages all the recourse require by each service and
also regulator each VMs, i.e., respiration signal collection and storage management,
signal enhancement and restoration, information extraction and classification and
lastly information acquisition.
1. Signal collection and storage management: this phase provides web-based
services to manipulate and store patient health information in the data.
2. Signal enhancement and restoration: this service is responsible for enhancing the
quality of decrypted signal.
3. Signal classification and analysis: this service is responsible for tracking and
monitoring activates.
IoT-Added Service This service records respiration signal and stores it. It provides
continuous monitoring by collecting patient respiration data continuously in both
outdoor and home conditions and securely transmitting them to communication
gateway. These services include signal capturing, feature extraction and classifica-
tion, and secure transformation. The healthcare advisor can access the data without
having any direct interaction with patients.

4 Proposed Health Monitoring Scheme

4.1 Signal Enhancement

To get rid of common glitches and noise from the recorded signal, it must be
enhanced before any kind of processing and feature extraction. In the enhancement
phase, low-pass filter is applied to the recorded signal to overwhelm high frequency
modules caused by noise. After that, the median filter was applied to eliminate
minute glitches. Figure 3 shows the effect of passing the signal through the low-pass
and median filters. The figure illustrates that the quality of the signal is improving
and looks clear after applying the low-pass and median filters.
82 S. T. U. Shah et al.

Fig. 3 The effect of low-pass and median filter on record signal: (a) recorded signal, (b) low-pass
filtered, and (c) median filter signal

4.2 Watermarking

This technique is used to protect signals from forgery. Through this technique, we
embed some specific information in the signal so that its credibility can be protected
and the signal will no longer intermix with other signals. This technique consists of
two parts which are watermark embedding and watermark extraction. Watermark
embedding adds some information to the respiration signal and guarantees the
authenticity. We used discrete wavelet transform (DWT) for this purpose. This
technique decomposes the respiration signal to four different frequencies of sub-
bands: horizontal details (HLi ), low-frequency details (Li), high-frequency details
(HHi ), and vertical details (LHi ). We apply the watermark embedding into those
coefficients having low frequencies [20]. We used IDWT technique to extract the
original details of the signal [21]. Watermark embedding to the signal is applied on
the client, while extraction is applied at cloud side.
Cloud-Assisted IoT-Based Smart Respiratory Monitoring System for Asthma Patients 83

4.3 Feature Extraction

At the cloud server side, different features are extracted from the respiration signal.
That includes calculating the breath rate/minute (bpm). Breath rate may vary
between 12 and 37 bpm, while the normal breath rate of an adult in resting position
is 12–20 bpm. The breath rate for a 1-year-old baby can vary between 30 and 40,
while in elders, it may vary between 12 and 30. To calculate the breath rate, we used
the algorithm in Fig. 4.

Algorithm_1 – CalculateRespiratoryRate

Input: Take numerical data of 20 seconds

Output: Breath Rate/Minute (bpm)
Place the data in resp[]
Numofpeaks = 0
for i = 0 to resp.length - 5
if(resp [i]< resp [i+2] && resp [i+1]< resp [i+2] &&
resp [i+3]> resp [i+2] && resp [i+4]> resp [i+2] )
Then
numofpeaks + 1
enf if
end for
bpm = numofpeaks x 3

In the algorithm described in Fig. 4, first of all, we will take data of 20 s from
the graph. In the next step, the data will be placed in an array. Next, using a sliding
window technique with having a size of 5 for each window, we identify the total
number of peak points. Through this we will compute each set of five elements; if

Fig. 4 Classification accuracy of the proposed scheme

84 S. T. U. Shah et al.

the central element is greater than the central point, then it will be considered as
peak point, and the numofpeak variable will be incremented. After computing all
the data in the array, the breath per minute is obtained by multiplying the resultant
numofpeak by 3.

5 Experimental Results and Evaluation

5.1 Classification Performance

For classification purposes, we performed two different kinds of experiments: one

with the data captured though the proposed approach and the other with data collect
from MIMIC II Waveform Database [22]. The experiential results and accuracy
rates of both databases were shown in Fig. 5. The accuracy was evaluated with
different features. With 40 features the accuracy rate reached to 87% with private
database and 83% with the MIMIC II database.

Fig. 5 Workload for the transmission of respiration signal

Cloud-Assisted IoT-Based Smart Respiratory Monitoring System for Asthma Patients 85

5.2 Workload of the Proposed System

Figure 5 shows the workload of the transmission services used by the proposed
system. The figure focuses on the transmission of respiration signal. The runtime
measurement of this service is collected using a Java-based simulator program. To
achieve this, we used a virtual machine with Intel core i3 1.7 GHZ processor, 3GB
DDR ECC RAM, 8MBPS bandwidth, and running windows server 2012.

6 Conclusion

IoT-based health monitoring is an emerging technology that can revolutionize the

health industry. In the hospital-centric healthcare service, patient health status is
recorded through different processes and devices. In this chapter, we developed
a smart, inexpensive, scalable, and efficient IoT-based cloud-assisted healthcare
monitoring framework for asthma patients. The proposed scheme provides remote
monitoring of patient health status anytime, anywhere, and enables healthcare
advisors to access, analyze, track, and monitor patient health status in a real-time
manner. To ensure security, the recorded signal was watermarked before sending to
the cloud server. The performance measurements and classification accuracy were
evaluated through experiments. Future work involves implementing the proposed
system with real patients and healthcare advisors as a test trial.

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