Method and apparatus for monitoring heart failure patients with cardiopulmonary comorbidities

• US 20060020295A1
• Filed: 07/23/2004
• Published: 01/26/2006
• Est. Priority Date: 07/23/2004
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Kadhiresan, Veerichetty, Carlson, Gerrard M., Hopper, Donald, Brockway, Marina, Beck, Kenneth
• Granted Patent: US 7,480,528 B2
• Time in Patent Office: Days
• US Class Current: 607/17
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/087 Measuring breath flow
• CPC Class Codes: A61B 5/4878 Evaluating oedema
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance

Abstract

A system receives signals indicative of cardiopulmonary conditions sensed by a plurality of sensors and provides for monitoring and automated differential diagnosis of the cardiopulmonary conditions based on the signals. Cardiogenic pulmonary edema is detected based on one or more signals sensed by implantable sensors. If the cardiogenic pulmonary edema is not detected, obstructive pulmonary disease and restrictive pulmonary disease are each detected based on a forced vital capacity (FVC) parameter and a forced expiratory volume (FEV) parameter measured from a respiratory signal sensed by an implantable or non-implantable sensor. In one embodiment, an implantable medical device senses signals indicative of the cardiopulmonary conditions, and an external system detects the cardiopulmonary conditions based on these signals by executing an automatic detection algorithm.

Claims

1. A system for detecting cardiopulmonary conditions, comprising:

a parameter input to receive parameters indicative of a plurality of cardiopulmonary conditions, the parameters including a forced vital capacity (FVC) parameter, a forced expiratory volume (FEV) parameter, and one or more edema-indicating parameters indicative of cardiogenic pulmonary edema;

a pulmonary edema detector coupled to the parameter input, the pulmonary edema detector adapted to detect the cardiogenic pulmonary edema based on the one or more edema-indicating parameters;

a low FVC detector coupled to the pulmonary edema detector, the low FVC detector adapted to detect a low FVC when the FVC parameter is below a predetermined threshold FVC parameter value if the cardiogenic pulmonary edema is not detected; and

a pulmonary condition detector coupled to the low FVC detector, the pulmonary condition detector adapted to detect at least an obstructive pulmonary disease and a restrictive pulmonary disease based on the FVC parameter and the FEV parameter if the low FVC is detected.

2. The system of claim 1, wherein the pulmonary condition detector comprises an obstructive pulmonary disease detector adapted to detect the obstructive pulmonary disease when a ratio of the FEV parameter to the FVC parameter is below a predetermined obstructive pulmonary disease threshold ratio.

3. The system of claim 2, wherein the pulmonary condition detector further comprises a restrictive pulmonary disease detector adapted to detect the restrictive pulmonary disease when the ratio of the FEV parameter to the FVC parameter exceeds a predetermined restrictive pulmonary disease threshold ratio.

4. The system of claim 3, further comprising a respiratory parameter generator coupled to the parameter input, the respiratory parameter generator including:

an FVC measurement module to measure the FVC parameter from a respiratory signal; and

an FEV measurement module to measure the FEV parameter from the respiratory signal.

5. The system of claim 4, wherein the respiratory signal comprises a spirometry signal, and further comprising a spirometry signal input, coupled to the respiratory parameter generator, to receive the respiratory signal from a spirometer.

6. The system of claim 4, wherein the respiratory signal comprises an impedance signal, and further comprising an impedance signal input, coupled to the respiratory parameter generator, to receive the impedance signal from an implantable impedance sensor.

7. The system of claim 6, further comprising an activity signal input, coupled to the respiratory parameter generator, to receive an activity signal indicative of a physical activity level from an implantable activity sensor, and wherein the FVC measurement module is adapted to measure the FVC parameter when the activity level is below a predetermined threshold level representing a substantially resting state, and the FEV measurement module is adapted to measure the FEV parameter when the activity level is below the predetermined threshold level representing the substantially resting state.

8. The system of claim 1, further comprising:

A cardiac signal input to receive one or more electrograms from an implantable sensing circuit; and

a heart rate variability (HRV) processor, coupled to the cardiac signal input and the parameter input, to produce one or more parameters of the one or more edema-indicating parameters based on the one or more electrograms, the HRV processor including an HRV measurement module to measure the HRV based on the one or more electrograms.

9. The system of claim 8, wherein the pulmonary edema detector comprises a low HRV detector adapted to indicate a detection of the cardiogenic pulmonary edema when the HRV is lower than a predetermined threshold HRV.

10. The system of claim 8, wherein the pulmonary edema detector comprises a low HRV detector adapted to indicate a detection of the cardiogenic pulmonary edema when a decrease in the HRV exceeds a predetermined margin.

11. The system of claim 8, wherein the HRV processor further comprises a very-low-frequency (VLF) HRV generator to produce a VLF HRV having a frequency band of about 0.0033 Hz to 0.04 Hz based on the HRV, and wherein the pulmonary edema detector comprises a high VLF HRV detector adapted to indicate a detection of the cardiogenic pulmonary edema when the VLF HRV exceeds a predetermined threshold VLF HRV.

12. The system of claim 8, wherein the HRV processor further comprises:

a low-frequency (LF) HRV generator to produce an LF HRV having a frequency band of about 0.04 Hz to 0.15 Hz based on the HRV;

a high-frequency (HF) HRV generator to produce an HF HRV having a frequency band of about 0.15 Hz to 0.40 Hz based on the HRV; and

a LF-HRV/HF-HRV ratio calculator to calculate a ratio of the LF HRV to the HF HRV,

wherein the pulmonary edema detector comprises a high LF-HRV/HF-HRV ratio detector adapted to indicate a detection of the cardiogenic pulmonary edema when the ratio of the LF HRV to the HF HRV exceeds a predetermined threshold ratio.

13. The system of claim 1, further comprising:

an impedance signal input to receive at least one impedance signal from an implantable impedance sensor; and

an impedance processor, coupled to the impedance signal input and the parameter input, to produce one or more parameters of the one or more edema-indicating parameters based on the at least one impedance signal.

14. The system of claim 13, wherein the impedance processor comprises a very-low-frequency (VLF) impedance signal generator to produce a VLF impedance having a frequency band of about 0.0033 Hz to 0.016 Hz based on the impedance signal, and wherein the pulmonary edema detector comprises a high VLF impedance detector adapted to indicate a detection of the cardiogenic pulmonary edema when the VLF impedance exceeds a predetermined threshold VLF impedance.

15. The system of claim 13, wherein the impedance processor comprises a direct current (DC) impedance signal generator to produce a DC impedance from the impedance signal, and wherein the pulmonary edema detector comprises a low DC impedance detector adapted to indicate a detection of the cardiogenic pulmonary edema when the DC impedance is below a predetermined threshold DC impedance.

16. The system of claim 1, further comprising:

a heart sound input to receive a heart sound signal from an implantable heart sound sensor; and

a third heart sound (S3) processor coupled to the heart sound input and the parameter input, the S3 processor including an S3 detector to detect occurrences of S3 and an S3 analyzer to produce one or more parameters of the one or more edema-indicating parameters based on the detected occurrences of S3.

17. The system of claim 16, wherein the S3 analyzer comprises an S3 amplitude measurement module to measure an S3 amplitude, and wherein the pulmonary edema detector comprises a high S3 amplitude detector adapted to indicate a detection of the cardiogenic pulmonary edema when the S3 amplitude exceeds a predetermined threshold amplitude.

18. The system of claim 16, wherein the S3 analyzer comprises an S3 index trending module to produce an S3 index being a ratio, or an estimate of the ratio, of a number of S3 beats to a number of all heart beats over a predetermined time interval, where the S3 beats are each a heart beat during which an occurrence of S3 is detected, and wherein the pulmonary edema detector comprises a high S3 index detector adapted to indicate a detection of the cardiogenic pulmonary edema when the S3 index exceeds a predetermined threshold index level.

19. The system of claim 1, wherein the one or more edema-indicating parameters comprise two or more of:

a heart rate variability (HRV);

a very-low-frequency (VLF) HRV suggestive of periodic breathing;

a ratio of low-frequency (LF) HRV to high-frequency (HF) HRV;

a very-low-frequency (VLF) impedance suggestive of periodic breathing;

a third heart sound (S3) amplitude;

an S3 index being a ratio, or an estimate of the ratio, of a number of S3 beats to a number of all heart beats over a predetermined time interval, where the S3 beats are each a heart beat during which an occurrence of S3 is detected; and

a DC impedance indicative of pulmonary fluid status,

wherein the pulmonary edema detector comprises two or more of;

a low HRV detector adapted to indicate a detection of the cardiogenic pulmonary edema when a measured HRV is lower than a predetermined threshold HRV;

a high VLF HRV detector adapted to indicate a detection of the cardiogenic pulmonary edema when the VLF HRV exceeds a predetermined threshold VLF HRV;

a high LF-HRV/HF-HRV ratio detector adapted to indicate a detection of the cardiogenic pulmonary edema when the ratio of the LF HRV to the HF HRV exceeds a predetermined threshold ratio;

a high VLF impedance detector adapted to indicate a detection of the cardiogenic pulmonary edema when the VLF impedance exceeds a predetermined threshold VLF impedance;

a high S3 amplitude detector adapted to indicate a detection of the cardiogenic pulmonary edema when the S3 amplitude exceeds a predetermined amplitude;

a high S3 index detector adapted to indicate a detection of the cardiogenic pulmonary edema when the S3 index exceeds a predetermined amplitude; and

a low DC impedance detector adapted to indicate a detection of the cardiogenic pulmonary edema when the DC impedance is below a predetermined threshold DC impedance.

20. The system of claim 19, wherein the pulmonary edema detector further comprises a cardiogenic pulmonary edema indicator coupled to the two or more of the low HRV detector, the high VLF HRV detector, the high LF-HRV/HF-HRV ratio detector, the high VLF impedance detector, the high S3 amplitude detector, the high S3 index detector, and the a low DC impedance detector, the cardiogenic pulmonary edema indicator adapted to indicate a detection of the cardiogenic pulmonary edema based on one or more detections of the cardiogenic pulmonary edema indicated by the two or more of the low HRV detector, the high VLF HRV detector, the high LF-HRV/HF-HRV ratio detector, the high VLF impedance detector, the high S3 amplitude detector, the high S3 index detector, and the low DC impedance detector.

21. The system of claim 1, further comprising a dyspnea detector coupled to the pulmonary edema detector, the dyspnea detector adapted to receive a respiratory signal and an activity signal and adapted to detect dyspnea manifested by rapid shallow breath based on the respiratory signal and the activity signal, and wherein the pulmonary edema detector is adapted to detect the cardiogenic pulmonary edema after each detection of the dyspnea.

22. A system, comprising:

an implantable medical device including;

one or more sensors adapted to sense one or more signals indicative of a plurality of cardiopulmonary conditions;

an implant processor, coupled to the one or more sensors, to process the one or more signals; and

an implant telemetry module, coupled to the implant processor, to transmit the processed one or more signals; and

an external system communicatively coupled to the implantable medical device via telemetry, the external system including;

an external telemetry module to receive the processed one or more signals; and

an external processor coupled to the external telemetry module, the external processor including a cardiopulmonary condition detector adapted to detect the plurality of cardiopulmonary conditions based on the processed one or more signals, the cardiopulmonary condition detector including at least a cardiogenic pulmonary edema detector, an obstructive pulmonary disease detector, and a restrictive pulmonary disease detector.

23. The system of claim 22, wherein the implantable medical device comprises an implantable cardiac rhythm management (CRM) device.

24. The system of claim 22, wherein the external system comprises a programmer.

25. The system of claim 22, wherein the external system comprises a patient management system including:

an external device communicatively coupled to the implantable medical device;

a telecommunication network coupled to the external device; and

a remote device, coupled to the telecommunication network, to allow access to the implantable medical device from a remote location.

26. The system of claim 25, wherein the remote device comprises the cardiopulmonary condition detector.

27. The system of claim 22, wherein the cardiopulmonary condition detector comprises a dyspnea detector adapted to detect dyspnea based on at least one dyspnea-indicating signal of the processed one or more signals, and wherein the pulmonary edema detector is adapted to detect a cardiogenic pulmonary edema after the dyspnea is detected.

28. The system of claim 22, wherein the one or more sensors comprise a sensing circuit to sense one or more electrograms, and the implant processor comprises a heart rate variability (HRV) processor adapted to measure an HRV from the one or more electrograms and adapted to produce one or more parameters indicative of cardiogenic pulmonary edema based on the HRV.

29. The system of claim 22, wherein the one or more sensors comprise an impedance sensor to sense a thoracic impedance, and the implant processor comprises a impedance processor adapted to produce one or more parameters indicative of cardiogenic pulmonary edema based on the thoracic impedance.

30. The system of claim 22, wherein the one or more sensors comprise a heart sound sensor to sense a heart sound signal indicative of at least third heart sounds (S3) , and the implant processor comprises an S3 processor adapted to detect occurrences of S3 and adapted to produce one or more parameters indicative of cardiogenic pulmonary edema based on the detected occurrences of S3.

31. The system of claim 22, wherein the obstructive pulmonary disease detector is adapted to detect an obstructive pulmonary disease based on an forced vital capacity (FVC) parameter and an forced expiratory volume (FEV) parameter, and the restrictive pulmonary disease detector is adapted to detect a restrictive pulmonary disease based on the FVC parameter and the FEV parameter.

32. The system of claim 31, wherein the cardiopulmonary condition detector further comprises a low FVC detector, coupled to the pulmonary edema detector, to detect a low FVC when the FVC parameter is less than a predetermined threshold FVC parameter value if the cardiogenic pulmonary edema is not detected, and wherein the obstructive pulmonary disease detector is adapted to detect the obstructive pulmonary disease if the low FVC is detected, and the restrictive pulmonary disease detector is adapted to detect the restrictive pulmonary disease if the low FVC is detected.

33. The system of claim 31, further comprising an external spirometer, coupled to the external system, to sense a spirometry signal indicative of lung volume, and wherein the external processor comprises:

an FVC measurement module adapted to measure the FVC parameter from the spirometry signal; and

an FEV measurement module adapted to measure the FEV parameter from the spirometry signal.

34. The system of claim 31, wherein the one or more sensors comprise an impedance sensor to sense an impedance signal indicative of minute ventilation, and the external processor comprises:

an FVC measurement module adapted to measure the FVC parameter from the impedance signal; and

an FEV measurement module adapted to measure the FEV parameter from the impedance signal.

35. The system of claim 34, wherein the one or more sensors further comprise an activity sensor to sense an activity signal indicative of a physical activity level, and wherein:

the FVC measurement module is adapted to measure the FVC parameter from the MV impedance signal when the activity signal indicates a substantially resting state; and

the FEV measurement module is adapted to measure the FEV parameter from the MV impedance signal when the activity signal indicates a substantially resting state.

36. A method for detecting cardiopulmonary conditions, comprising:

receiving signals indicative of a plurality of cardiopulmonary conditions;

executing an automatic detection algorithm, the executing including;

detecting cardiogenic pulmonary edema based on at least one edema-indicating signal of the received signals;

measuring a forced vital capacity (FVC) parameter and a forced expiratory volume (FEV) parameter from at least one signal of the received signals;

detecting an obstructive pulmonary disease based on the measured FVC parameter and the measured FEV parameter if the cardiogenic pulmonary edema is not detected; and

detecting a restrictive pulmonary disease based on the measured FVC parameter and the measured FEV parameter if the cardiogenic pulmonary edema is not detected.

37. The method of claim 36, wherein executing the automatic detection algorithm further comprises detecting a low FVC if the cardiogenic pulmonary edema is not detected, and wherein detecting the obstructive pulmonary disease comprises detecting the obstructive pulmonary disease if the low FVC is detected, and detecting the restrictive pulmonary disease comprises detecting the restrictive pulmonary disease if the low FVC is detected.

38. The method of claim 36, further comprising detecting dyspnea based on at least one dyspnea-indicating signal of the received signals, and wherein detecting the cardiogenic pulmonary edema comprises detecting the cardiogenic pulmonary edema after the dyspnea is detected.

39. The method of claim 38, wherein receiving the signals comprises receiving a respiratory signal and an activity signal, and wherein detecting the dyspnea comprises detecting dyspnea when the respiratory signal indicates rapid and shallow breath and the activity signal indicates that the rapid and shallow breath is substantially unrelated to physical activity.

40. The method of claim 36, wherein receiving the signals comprises receiving a signal indicative of a heart rate variability (HRV), and wherein detecting the cardiogenic pulmonary edema comprises detecting the cardiogenic pulmonary edema based on the HRV.

41. The method of claim 36, wherein receiving the signals comprises receiving a signal indicative of a very-low-frequency heart rate variability (VLF HRV), and wherein detecting the cardiogenic pulmonary edema comprises detecting the cardiogenic pulmonary edema based on the VLF HRV.

42. The method of claim 36, wherein receiving the signals comprises receiving a signal indicative of a ratio of low-frequency heart rate variability (LF HRV) to a high-frequency heart rate variability (HF HRV), and wherein detecting the cardiogenic pulmonary edema comprises detecting the cardiogenic pulmonary edema based on the ratio of the LF HRV to the HF HRV.

43. The method of claim 36, wherein receiving the signals comprises receiving a signal indicative of a very-low-frequency (VLF) impedance suggestive of periodic breathing, and wherein detecting the cardiogenic pulmonary edema comprises detecting the cardiogenic pulmonary edema based on the VLF impedance.

44. The method of claim 36, wherein receiving the signals comprises receiving a signal indicative of a direct current (DC) impedance indicative of pulmonary fluid status, and wherein detecting the cardiogenic pulmonary edema comprises detecting the cardiogenic pulmonary edema based on the DC impedance.

45. The method of claim 36, wherein receiving the signals comprises receiving a signal indicative of a third heart sound (S3) amplitude, and wherein detecting the cardiogenic pulmonary edema comprises detecting the cardiogenic pulmonary edema based on the S3 amplitude.

46. The method of claim 36, wherein receiving the signals comprises receiving a signal indicative of a third heart sound (S3) index being a ratio, or an estimate of the ratio, of the number of S3 beats to the number of all heart beats detected during a predetermined period of time, the S3 beats being a heart beat during which an occurrence of S3 is detected, and wherein detecting the cardiogenic pulmonary edema comprises detecting the cardiogenic pulmonary edema based on the S3 index.

47. The method of claim 36, wherein receiving the signals comprises receiving an impedance signal indicative of minute ventilation from an implantable impedance sensor, and wherein measuring the FVC parameter and the FEV parameter comprises measuring the FVC parameter and the FEV parameter from the impedance signal.

48. The method of claim 47, wherein receiving the signals comprises receiving an activity level signal indicative of a physical activity level, and wherein measuring the FVC parameter and the FEV parameter comprises measuring the FVC parameter and the FEV parameter when the activity level is below a predetermined threshold level.

49. The method of claim 36, wherein receiving the signals comprises receiving a spirometry signal indicative of respiratory volumes from a spirometer, and wherein measuring the FVC parameter and the FEV parameter comprises measuring the FVC parameter and the FEV parameter from the spirometry signal.

50. The method of claim 36, wherein executing the automatic detection algorithm further comprises calculating a ratio of the FEV parameter to the FVC parameter, and wherein detecting the obstructive pulmonary disease comprises detecting the obstructive pulmonary disease when the ratio of the FEV parameter to the FVC parameter is below a predetermined obstructive pulmonary disease threshold ratio, and detecting the restrictive pulmonary disease comprises detecting the restrictive pulmonary disease when the ratio of the FEV parameter to the FVC parameter exceeds a predetermined restrictive pulmonary disease threshold ratio.

51. The method of claim 50, wherein measuring the FEV parameter comprises measuring the FEV parameter at about 1.0 second after the beginning of an expiratory phase of a respiratory cycle.

52. The method of claim 36, further comprising starting, stopping, or adjusting a therapy based on a result of the executing the automatic detection algorithm.

53. The method of claim 52, further comprising optimizing the therapy based on the result of the executing the automatic detection algorithm on a continuous basis.

54. The method of claim 52, further comprising optimizing the therapy based on the result of the executing the automatic detection algorithm on a periodic basis.

55. The method of claim 52, wherein the therapy comprises one or more of a drug therapy, an electrical therapy, and a biological therapy.

56. A method for monitoring cardiopulmonary conditions, comprising.

sensing signals indicative of a plurality of cardiopulmonary conditions using implantable sensors;

producing parameters based on the signals; and

detecting the plurality of cardiopulmonary conditions based on the parameters,

wherein the plurality of cardiopulmonary conditions includes at least cardiogenic pulmonary edema, an obstructive pulmonary disease, and a restrictive pulmonary disease.

57. The method of claim 56, wherein sensing the signals comprises sensing one or more electrograms indicative of heart rate variability (HRV), and producing the parameters comprises measuring an HRV from the one or more electrograms.

58. The method of claim 57, wherein detecting the plurality of cardiopulmonary conditions comprises detecting the cardiogenic pulmonary edema when the HRV is lower than a predetermined threshold HRV.

59. The method of claim 57, wherein producing the parameters further comprises producing a very-low-frequency (VLF) HRV including components of the HRV in a frequency band of about 0.0033 Hz to 0.04 Hz, and wherein detecting the plurality of cardiopulmonary conditions comprises detecting the cardiogenic pulmonary edema when the VLF HRV exceeds a predetermined threshold VLF HRV.

60. The method of claim 57, wherein producing the parameters further comprises:

producing a low-frequency (LF) HRV including components of the HRV in a frequency band of about 0.05 Hz to 0.15 Hz;

producing a high-frequency (HF) HRV including components of the HRV in a frequency band of about 0.15 Hz to 0.40 Hz; and

calculating a ratio of the LF HRV to the HF HRV,

wherein detecting the plurality of cardiopulmonary conditions comprises detecting the cardiogenic pulmonary edema when the ratio of the LF HRV to the HF HRV exceeds a predetermined threshold ratio.

61. The method of claim 56, wherein sensing the signals comprises sensing a heart sound signal indicative of at least third heart sounds (S3) , and producing the parameters comprises detecting occurrences of S3 from the heart sound signal.

62. The method of claim 61, wherein producing the parameters further comprises producing an S3 amplitude based on the detected occurrences of S3, and detecting the plurality of cardiopulmonary conditions comprises detecting the cardiogenic pulmonary edema when the S3 amplitude exceeds a predetermined threshold amplitude.

63. The method of claim 61, wherein producing the parameters further comprises producing an S3 index based on the detected S3, the S3 index being a ratio, or an estimate of the ratio, of the number of S3 beats to the number of all heart beats detected during a predetermined period of time, the S3 beats being a heart beat during which an occurrence of S3 is detected, and detecting the plurality of cardiopulmonary conditions comprises detecting the cardiogenic pulmonary edema when the S3 index exceeds a predetermined threshold index level.

64. The method of claim 61, wherein sensing the heart sound signal comprises sensing an acceleration signal.

65. The method of claim 56, wherein sensing the signals comprises sensing a thoracic impedance.

66. The method of claim 65, wherein producing the parameters comprises producing a DC impedance based on the thoracic impedance, the DC impedance indicative of a pulmonary fluid status, and detecting the plurality of cardiopulmonary conditions comprises detecting the cardiogenic pulmonary edema when the DC impedance exceeds a predetermined threshold DC impedance.

67. The method of claim 65, wherein producing the parameters comprises producing a very-low-frequency VLF impedance based on the thoracic impedance, the VLF impedance suggestive of periodic breathing, and detecting the plurality of cardiopulmonary conditions comprises detecting the cardiogenic pulmonary edema when the VLF impedance exceeds a predetermined threshold VLF impedance;

68. The method of claim 67, wherein producing the VLF impedance comprises extracting VLF components of the thoracic impedance signal, the VLF components having a frequency band of about 0.0033 Hz to 0.016 Hz.

69. The method of claim 65, wherein producing the parameters comprises:

producing a minute ventilation (MV) impedance signal based on the thoracic impedance, the MV impedance signal indicative of minute ventilation; and

measuring a force vital capacity (FVC) parameter and a forced expiratory volume (FEV) parameter from the MV impedance signal.

70. The method of claim 69, wherein sensing the signals comprises sensing an activity signal indicative of physical activity level, producing the parameters comprises producing the physical activity level based one the activity signal, and measuring the FVC parameter and the FEV parameter comprises measuring the FVC parameter and the FEV parameter when the physical activity level is below a predetermined threshold level representing a substantially resting state.

71. The method of claim 70, wherein sensing the activity signal comprises sensing an acceleration signal.

72. The method of claim 70, wherein detecting the plurality of cardiopulmonary conditions comprises detecting a low FVC when the measured FVC parameter is below a predetermined threshold FVC parameter value if the cardiogenic pulmonary edema is not detected.

73. The method of claim 72, wherein producing the parameters further comprises calculating a ratio of the FEV parameter to the FVC parameter, and detecting the plurality of cardiopulmonary conditions comprises:

detecting the obstructive pulmonary disease when the ratio of the FEV parameter to the FVC parameter is below a predetermined obstructive pulmonary disease threshold ratio if the low FVC is detected; and

detecting the restrictive pulmonary disease when the ratio of the FEV parameter to the FVC parameter exceeds a predetermined restrictive pulmonary disease threshold if the low FVC is detected.

74. The method of claim 56, further comprising optimizing a therapy in response to a detection of one of the cardiogenic pulmonary edema, the obstructive pulmonary disease, and the restrictive pulmonary disease.

75. The method of claim 74, wherein optimizing a therapy comprises optimizing a drug therapy.

76. The method of claim 74, wherein optimizing a therapy comprises optimizing an electrical therapy.

77. The method of claim 74, wherein optimizing a therapy comprises optimizing a biological therapy.