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Intelligent Diagnosis of Asthma Using Machine Learning Algorithms

Article  in  International Journal of Sciences: Basic and Applied Research (IJSBAR) · July 2014

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International Research Journal of Applied and Basic Sciences
© 2013 Available online at www.irjabs.com
ISSN 2251-838X / Vol, 4 (12): 4041-4046
Science Explorer Publications

Intelligent Diagnosis of Asthma Using Machine

Learning Algorithms
TahaSamadSoltaniHeris1, MostafaLangarizadeh2, Zahra Mahmoodvand3,
Maryam Zolnoori4
1. PhD student of medical informatics, the College of Paramedics , Tehran University of Medical Science Tehran ,
Iran
2. assistant professor in medical informatics, the College of Paramedics, Tehran University of Medical Sciences ,
Tehran , Iran
3. M.Sc. student of health information technology, the College of Management and Medical Information , Tehran
University of Medical Sciences , Tehran, Iran
4.post – doctoral student in health informatics , the College of Informatics , the State University of Indiana , The
United States of America
*
Corresponding Author email: t-ssoltany@razi.tums.ac.ir

ABSTRACT: Data mining in healthcare is a very important field in diagnosis and in deeper understanding
of medical data. Health data mining intends to solve real- world problems in diagnosing and treating
diseases. One of the most important applications of data mining in the domain of machine learning is
diagnosis, and this type of diagnosis of the disease asthma is a notable challenge due to the lack of
sufficient knowledge of physicians concerning this disease and because of the complexity of asthma. The
purpose of this research is the skillful diagnosis of asthma using efficient algorithms of machine learning.
This study was conducted on a dataset consisting of 169 asthmatics and 85 non - asthmatics visiting the
Imam Khomeini and MasseehDaneshvari Hospitals of Tehran. The algorithms of k – nearest neighbors ,
random forest , and support vector machine, together with pre – processing and efficient training were
implemented on this dataset ,and the degrees of accuracy and specificity of the system used in our study
were calculated compared with each other and with those of previous research. From among the
different values for neighborhood, the highest degree of specificity was achieved with five neighbors. Our
method was investigated together with other methods of machine learning and similar research, and the
ROC curve was plotted, too. Other methods achieved suitable results as well, and they can be relied on.
Therefore, we propose our approach based on the k- nearest algorithm together with pre-processing
based on the Relief – F strategy and the Cross Fold data sampling as an efficient method in artificial
intelligence with the purpose of data mining for the classification and differential diagnosis of diseases.
Keywords: asthma, Data mining, Diagnosis, intelligent systems,machine learning.

INTRODUCTION

Data mining is an important step in discovering and extracting knowledge and implies exploring large
datasets with the purpose of extracting unknown patterns among(Han 2005). Since discovering relations among
data is very difficult in traditional statistical methods(Lee, Liao et al. 2000), this is not a new approach and it is
widely in financial institutions in areas such as recognizing fraud and pricing. Salespersons and retailers use this
approach in dividing their markets and in distributing their products among warehouses, and manufacturers employ
it for controlling quality and for scheduling maintenance and repairs (Koh and Tan 2011). Data mining applications
have rapidly spread in large sections of organizations offering medical care, in financial predictions, and in weather
forecasting (Obenshain 2004).There is a high potential for data mining applications in healthcare. These
applications can be grouped, in general, into evaluation of the effects of treatments, management of healthcare,
management of relations with patients, and recognition of fraud and misuse. More specialized data mining includes
medical diagnosis and analysis of DNA micro- arrays (Koh and Tan 2011).
Intl. Res. J. Appl. Basic. Sci. Vol., 4 (12), 4041-4046, 2013

Data mining is a very important field in diagnosis and in deeper understanding of medical data. Health data
mining aims to solve real- world problems in diagnosis and in disease treatment(Liao and Lee 2002); and also , in
healthcare, it is also considered to be an important area for research in predicting diseases and in gaining a more
profound understanding of health data. The purpose of health data mining is the resolution of real- world health
problems in diagnosis and disease treatment (Liao and Lee 2002). Researchers use this method to diagnose
different diseases and, to this end, employ various approaches and algorithms with different specificity and
accuracy (Shouman, Turner et al. 2012).
Methods and algorithms of data mining have been used in diagnosing diseases. The most important of
these studies include the automatic diagnosis of the skin disease erythemato-squamous in which these methods
and algorithms are employed (Güvenir, Demiröz et al. 1998; Übeylı and Güler 2005; Übeyli and Doğdu 2010; Xie
and Wang 2011; Abdi and Giveki 2013). Data classification is carried out by using a variety of methods including k
– nearest neighbor, support vector machine, and random forest, which are popular methods for multi – class
diagnosis in the area of pattern recognition (Athitsos 2005). These are the most commonly used methods in data
mining and classification (Moreno-Seco, Micó et al. 2003). In this article, we use the above – mentioned algorithms
for the diagnosis of the disease asthma in order to achieve a suitable efficiency in its diagnosis.

METHODS AND MATERIALS

The process of solving the problem was modeled in steps to obtain the desired output. In these steps,
which are shown in Figure 1, the processes of organizing the input, pre-processing, data sampling, adjusting the
parameters of the algorithms, executing the algorithms, and analyzing the outputs were carried out.
Figure1. Common steps in carrying out data mining recommended in the data mining software Orange for
classification:

Organizing input data → Pre-processing → Data sampling → Adjusting the algorithm → Executing the algorithm →
Evaluating the output

Organizing input data

In this research, the dataset regarding patients visiting the Imam Khomeini and the MasseehDaneshvari
Hospitals of Tehran was used(Zolnoori, Zarandi et al. 2007). The dataset contains 250 records consisting of 24
input features and one discrete output feature shown in Table 1. Each of these features has a range of numerical
values. For example, coughing, depending on its severity, may have values from zero to 50. Output classes also
include the two classes of zero and one, which denote those diagnosed with and those not diagnosed with asthma.

Table 1. Features in the dataset concerning the disease asthma which are used in this research
Asthma disease Features
(numberof patients)
Asthma(169) Feature 1: Parent1 Feature 13: history of eczema or hay fever
Non Asthma(85) Feature 2: Parent2 Feature 14: Hospitalization before age 3
Feature 3:Rel Feature 15: allergy to food before age 3
Feature 4: allergic rhinitis Feature 16: cold status
Feature 5: BMI Feature 17: air pollution
Feature 6: gastro esophageal reflux Feature 18: exposure to smoking
Feature 7: Reaction to Allergens Feature 19: mother smoking in pregnancy
Feature 8: Reaction to Irritants Feature 20: exposure to pets in childhood
Feature 9: Reaction to Emotion Feature 21: high damper in house or humid climate
Feature 10: chest tightness Feature 22:cough
Feature 11: Exercise induced Symptoms Feature 23: phlegm
Feature 12: Dyspnea Feature 24: wheeze

Pre - processing
The pre-processing of data is an important step in the process of data mining. In data mining, the methods
of data collection are not very controlled and outlier, repetitive, and wrong values may result in obtaining invalid
output. Therefore, it is necessary to take a set of actions before utilizing data to ensure good quality (Pyle 1999). If
the information used in the processes of extracting knowledge and educating contains redundant or irrelevant data,
it will be very difficult to carry out these processes. The pre-processing step may be time – consuming and include
processes such as the cleaning, normalization, conversion, and extraction of features. The output of this step will
be the training set (Kotsiantis, Kanellopoulos et al. 2006). In this study, the pre-processing of data was conducted
in two steps. In the first step, incomplete data was eliminated from the dataset in order to achieve better agreement

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in later stages. The second step consisted of the selection of the features based on the strategy and algorithm of
Relief – F. In the strategy of Relief – F, which is one of the most successful methods of selecting features (Liu and
Motoda 2008), samples are randomly chosen, and the weight of each feature is calculated based on the nearest
neighbor. After experimenting with the different values of the features and calculating the outputs, 15 superior
features were selected and applied as the input for the algorithm.

Data sampling
In the data-sampling step, a subset of data is extracted from the input dataset. This is performed for
sampling and for dividing the data into the two classes of training and testing data. In this research, the cross
validation method was used. This method is employed for estimating common errors based on numerous sampling,
and the result of such estimation is usually used for selecting from among various models including network
architecture. In the k- fold CV method, the data and the samples are divided into k almost equal subsets. The
network is then tested k times and each time one of the subsets is omitted (Sarle 2012 ). In our research, we
divided the data and the samples into 10 subsets and calculated the accuracy and sensitivity of the outputs to
make the necessary. After investigating the best accuracies and sensitivities, 26 records were selected for
modeling and 228 records remained.

Adjusting the algorithm

In this step, the parameters of the algorithms are tested and evaluated by using different values in order to
find the best possible result in the system output. The values of neighborhood, the resolution type, and the number
of trees are the parameters in the k – nearest neighbor, the support vector machine, and the random forest
algorithms, respectively.

Executing the algorithm

The k – nearest neighbor algorithm
The KNN algorithm, also called the memory – based classification method, is one of easiest and most
direct techniques of data mining (Alpaydin 1997). In this method, differences between features are calculated by
using Euclidean distances in order to work with continuous and discrete features. For example, if the first sample is
( and the second sample ( , then the distance between them is calculated using
formula 1:
√ (1)

The most difficult problem in employing the formula of Euclidean distances is that larger values often flood
smaller ones. The KNN algorithm usually works with continuous data but it is efficient for discrete data as well. If
the discrete values in the hypothetical samples differ from each other, this difference will be considered
one; and if they do not differ from each other, the difference will be considered zero (Shouman, Turner et al. 2012).
The algorithm was run at different neighborhood values until the highest levels of sensitivity and specificity were
achieved (which will be referred to in the section on results).

The support- vector machine (SVM) algorithm

Vapnik et al. (Cortes and Vapnik 1995) introduced the support - vector machine (SVM) algorithm as a very
efficient method for the purpose of pattern recognition. The SVM is a powerful tool for data classification. This
algorithm allocates semi – discrete spaces, together with the space of the original data, to two sets of data in linear
classification and in high- level dimensions in non-linear classification (Fung and Mangasarian 2005). In
classification, data is usually separated into the two sets of training and testing data. Each sample in the training
set includes the target value (output). The purpose in SVM is to produce a model based on training data in such a
way that the model can predict the target values of the training set (Hsu, Chang et al. 2003). A support- vector
machine produces a hyperplane, or a set of hyperplanes, in a high – dimensional space. These hyperplanes can
be used for classification, regression or for other applications. Good separations are performed by hyperplanes that
have the longest distances to the nearest points of the training data in each class (Deepa and Thangaraj 2011).

The random forest algorithm

The random forest (s) algorithm is a general classification method consisting of a large number of decision
trees and class outputs, each output being implemented by specific trees. Leo Breiman and Adele Cutler
introduced the random - forest deduction algorithm (Ho 1995). Random forests are combinations of computational
trees each of which is related to values of random vectors that are independently sampled; and the same

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distribution is applied for all the trees in the forest. This classification algorithm consists of a set of tree
classifications which has the form of {…, h(x, , in which { are the random vectors that have been
distributed independently and in the same way. Each tree has a single vote for the most favorite input class x
(Breiman 2001).

Evaluating the output

Output evaluation was performed on the basis of sensitivity analysis , accuracy , specificity , the plotting of
the confusion matrix , and the plotting of the ROC curve (Zhu, Zeng et al. 2010).Relations 2 , 3 , and 4 were used
to calculate sensitivity , specificity , and accuracy.
Sensitivity is the ratio of correct positive diagnoses that are correctly revealed by a specific test. Based on
this definition, one hundred percent sensitivity implies correct diagnoses of the disease in all patients:
Sensitivity = (2)
The statistical measure determining the accuracy of the test for the purpose of identifying the negative diagnoses is
called specificity.
Accuracy= (3)
Finally, the following formula is used to calculate sensitivity:
Accuracy =

(4)

RESULTS AND DISCUSSION

This research was conducted in the area of clinical diagnosis in the Canvas Orange data mining
environment and implemented in the Python language. The input features for the application program prepared are
listed in Table 1. The suitable performance of the algorithms depends on the sizes of the training and testing
datasets. A set of identical samples of the same size was employed for evaluating and comparing the implemented
algorithms.
We obtained an optimal output for training the SVM from the RBF kernel functions by adjusting the cost
parameters and the numerical accuracy of 2, 001, and zero, respectively. Euclidean distances were used in the
nearest – neighbor algorithm, weighting was performed based on these distances, and the continuous values were
normalized. In the random forest method , twenty trees were used.
Table 2 in the section on results shows sensitivity, specificity, and accuracy of the results of the algorithms
in the diagnosis of asthma. The results of our study were compared with the outputs of the fuzzy expert system
designed by Zarandi et al. based on this dataset. Note that every time the program is run these values undergo
change because the samples had been randomly taken. These values change and so we stopped the iteration
process after obtaining 100 percent specificity, sensitivity, and accuracy from one of the methods.

Table 2. Results of the analysis of the outputs of our study and comparison of these results with those obtained by other
researchers concerning asthma
Algorithm Description Class Accuracy Sensitivity Specifity
1 1 1 1
KNN K=5
0 1 1 1
2 1 0.9870 0.9934 0.9737
SVM Exp(-g|x-y| )
0 0.9870 0.9737 0.9934
1 0.9652 0.9868 0.9211
RF Number of trees=20
0 0.9652 0.9211 0.9868
Fuzzy Expert system(Zarandi,
Fuzzy 1 - 0.94 1
Zolnoori et al. 2010)
Computer-Assisted, Symptom-
Decision Rule Based Diagnosis(Choi, Yoo et 1 - 0.562 0.935
al. 2007)
CAIDSA(Chakraborty, Mitra et
Decision Rule 1 0.90 - -
al. 2009)

In the nearest – neighbor method, the best results were obtained when there were five neighbors, because
this k value corresponds to the specificity, accuracy, and sensitivity values of one. In the SVM method, the best
results were achieved, i.e., specificity, sensitivity, and accuracy were 0.9934, 0, 9737, and 0.9870, respectively,

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when the radial basis function, which is a non – linear method, was used(Chang, Hsieh et al. 2010). In the random
forest method, in which the number of trees was 20, the values for specificity, sensitivity, and accuracy were
0.9868, 0.9211, and 0.9652, respectively. For all values, both output classes of zero and one, which stand for
people diagnosed and not diagnosed with asthma, were calculated. Of course, class 1 has more applications.
The confusion matrices for all three algorithms are shown in Figure 1. They indicate the numbers of false and
correct positive diagnoses, and the numbers of false and correct negative diagnoses.

Figure 1. The matrices of confusion for the algorithms used in the study.

The ROC curve was plotted to reveal and evaluate the efficiency of the system. The nearer the points are
to the top left part of the curve, the more suitable they will be and the closer the prediction model will be to its ideal
state (Metz 1978).The curves for all three algorithms are shown in Figure 2.

Figure 2. The ROC curves for the machine learning algorithms used in our research. Colors represent different training methods
that were employed.

The results obtained from our research, the findings of studies carried out in which the dataset we used
was employed, and the conclusions drawn in similar research on diagnosing asthma are compared , and important
points are revealed and listed , in Table 2.
In 2010, FazelZarandi et al. introduced a fuzzy method for diagnosing the disease asthma in the dataset
used in our study (29). The general specificity and sensitivity of the classification of their model were 100 and 94
percent, respectively. The algorithms we used in our study yielded better results than the fuzzy method with
respect to the sensitivity of the diagnosis.
In another research titled “Easy diagnosis of asthma: computer – assisted, symptom – based diagnosis”,
the specificity and sensitivity obtained were 93.5 and 56.2 percent, respectively (30). This study was conducted
using questionnaires and the general diagnosis of the disease was offered by calculating the sum of the scores
given. The evaluation indices in our research are much more efficient and are better, compared to those employed
in this study.

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Chakraborty et al. (2009) also proposed a system for the intelligent diagnosis of asthma with an accuracy
of 90.03 percent. In this research, a neural network and decision rules were used (31). This system has a weaker
performance than ours (in which we obtained an accuracy of 96.52 to 100 percent).
In this study, three approaches of the K – nearest neighbor, the random forest, and the support – vector
machine algorithms together with pre – processing based on the Relief – F strategy and the Cross Fold data
sampling are proposed for data mining the dataset on asthma for diagnosing this disease.
The highest efficiency for the k-nearest neighbor algorithm was achieved when there were five neighbors,
because in this situation all cases of the disease were correctly diagnosed. The other algorithms also performed
better than the study based on the fuzzy expert system. Efficient pre – processing omits incomplete and
problematic data, discretizes values through the use of discretization techniques, adopts a suitable training
algorithm , selects and estimates appropriate algorithm parameters, and , thereby, greatly affects the output and
performance of classification methods.

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