Breath Sounds: What Do They Mean?

Below are the outcomes Nursing quiz on lung auscultation. This revealed the necessity to elucidate common adventitious lung sounds and the clinical conditions commonly related to them.

Different kinds of respiratory sounds

Let’s take a look at probably the most common incidental lung sounds. Remember that respiratory sounds are generated by the flow of air into and out of the lungs and ought to be characterised by the pitch, intensity, quality, and relative duration of the inspiratory and expiratory phases.

Wheeze

A (also called a wheeze) is a high-pitched, continuous, musical (whistling) sound which will occur during inspiration and/or expiration, resulting from narrowing or obstruction of the airways. Longer, higher-pitched wheezing is related to greater degrees of obstruction. Wheezing is most frequently heard with bronchospasm in acute exacerbations of asthma or exacerbations of acute or chronic bronchitis.

Snore

In other words, what we frequently call “sounding wheezing” refers to a deep, low-pitched rumbling or rough respiratory sound as air moves through the tracheobronchial passages within the presence of mucus or respiratory secretions. These are sometimes more pronounced during exhalation and usually tend to be prolonged, continuous, and fewer discrete than crackles. Rhonchi can sometimes be cleared by coughing.

Stridor

Stridor is a high-pitched, monophonic inspiratory sound, normally loudest over the anterior neck as air moves turbulently over a narrowing within the upper airway. The presence of stridor indicates upper airway spasm or partial obstruction and should occur with infection, upper airway abscess, ingestion of a foreign body, or some congenital anomalies.

Crackling

or are short, high-pitched, discrete, discontinuous, crackling sounds produced by air being forced through the airways or alveoli constricted by fluid, pus, or mucus. These breath sounds might also be heard when there’s a delayed opening of collapsed alveoli. The crackles don’t subside with coughing.

Crackles are frequently heard during inspiration and could be further defined as coarse or fantastic. They are lower pitched, heard during early inspiration and sound rough, loud or moist. They are brought on by mucus within the larger bronchioles, as heard in COPD. They are higher pitched, heard during late inspiration and may sound like hairs rubbing together. These sounds arise within the small airways/alveoli and could be heard in interstitial pneumonia or pulmonary fibrosis.

Lung sounds and clinical conditions

Asthma

Asthma is a medical condition brought on by inflammation. The physiological response of the airways is bronchial constriction and swelling of the airways. This response is triggered by an irritant, allergen, or infection. As air moves through these narrowed airways, the first lung sound is a high-pitched wheeze. Initially, the wheezing is expiratory, but depending on confounding aspects or worsening clinical symptoms, inspiratory wheezing, rales, or crackles may occur. However, for testing purposes, expiratory wheezing is related to asthma.

Pulmonary fibrosis

Pulmonary fibrosis is a type of interstitial lung disease wherein scarring (or fibrosis) is a characteristic clinical feature. Scarring results in thickening and stiffness of the lungs. The most typical incidental breath sound related to pulmonary fibrosis is fantastic bibasilar crackles (lower lobes of each lungs). These could also be difficult to differentiate from congestive heart failure. The crackles are the results of collapsed, stiff air sacs opening.

Neuromuscular disease

Neuromuscular disorders may cause respiratory problems through several mechanisms since the muscles chargeable for respiratory are affected. Weakness of the diaphragm can result in hypoventilation; weakness of the chest wall muscles can result in ineffective coughing; and weakness of the upper airway muscles can result in difficulty swallowing and ineffective clearance of upper airway secretions. Generally, there are not any specific adventitious breath sounds related to neuromuscular disorders.

Pneumothorax

A pneumothorax is a collapsed lung. In the world of ​​the pneumothorax, there could also be a lack of breath sounds because there isn’t a air movement in the world of ​​auscultation.

This brings us to the right answer. On auscultation of the lungs, crackles are heard in pulmonary fibrosis, which is answer B.

Reviewing what you realize and eager about each answer selection can aid you deal with the right answer. Do you could have a simple acronym or a pearl for remembering breath sounds or any test-taking strategies you possibly can share?

Hinkle, J., Cheever, K., and Overbaugh, K. (2021). Philadelphia: Wolters Kluwer Health.

Stewart, JBJDJFBSR ([Insert Year of Publication]). (tenth ed.). Elsevier Health Sciences (USA).