Validation of a new automated and privacy-preserving cough monitor

Background Objective cough monitoring is increasingly important for chronic cough assessment and therapeutic evaluation, yet existing systems may be limited by privacy concerns, user burden, and challenges associated with prolonged real-world monitoring. Aim To evaluate the diagnostic performance and acceptability of the C-mo System, a multimodal wearable cough monitor integrating abdominal electromyography (EMG) and EMG-triggered audio acquisition. Methods In this multicentre prospective study ( NCT05989698 ), consecutive participants with cough underwent 24 h of ambulatory monitoring using the C-mo system. Cough detection performance was evaluated against a continuous audio reference standard using blinded annotation. Sensitivity, specificity and false-positive rate were calculated overall and across age, body mass index (BMI), cough frequency, and comorbidities subgroups. Acceptability was assessed using a study-specific questionnaire. Results Fifty-four participants completed monitoring, contributing 1344 h of recordings. Mean monitoring duration was 24 h 54 min [24 h 50 min–24 h 58 min], with C-mo's EMG-based privacy mechanism limiting audio recording to 17.7% of the monitoring time. Sensitivity, specificity and false-positive rate were 93.81% (Q1 80.43, Q3 97.96), 99.97% (Q1 99.95, Q3 99.99) and 0.95 coughs/hour (Q1 0.47, Q3 1.71), respectively. Diagnostic performance remained consistently high across subgroups. Participants reported high levels of comfort, and acceptability, with favourable responses exceeding 80% across all questionnaire domains. Overall satisfaction was high, and most participants considered prolonged monitoring acceptable. Conclusion The C-mo system demonstrated high diagnostic accuracy and acceptability during prolonged real-world monitoring. These findings support the feasibility of multimodal, privacy-conscious ambulatory cough monitoring and provide a foundation for future long-term applications.