Respiratory sounds
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Respiratory sounds
Other names Breath sounds, lung sounds
1) area for normal tracheal sound, 2) area for auscultation of upper lung
fields, 3) area for normal bronchial sound. Blue marks auscultation area
and red line marks heart.
Specialty Respirology
Respiratory sounds refer to the specific sounds generated by the movement of
air through the respiratory system. These may be easily audible or identified
through auscultation of the respiratory system through the lung fields[1] with
a stethoscope as well as from the spectral characteristics of lung sounds. [2] These
include normal breath sounds and adventitious or "added" sounds such
as crackles, wheezes, pleural friction rubs, stertor, and stridor.
Description and classification of the sounds usually involve auscultation of the
inspiratory and expiratory phases of the breath cycle, noting both the pitch
(typically described as low, medium or high) and intensity (soft, medium, loud or
very loud) of the sounds heard.
Contents
1Abnormal breath sounds
o 1.1Continued
2Other tests of auscultation
3History
4References
5External links
Abnormal breath sounds[edit]
Common types of abnormal breath sounds include the following: [3]
Name Continuous/discontinuous Frequency/Pitch Inspiratory/expiratory Quality
Wheeze or rhonch high (wheeze) or
continuous expiratory or inspiratory whistling/sibilant, musical
i lower (rhonchi)
Stridor continuous high either, mostly inspiratory whistling/sibilant, musical
Inspiratory gasp continuous high inspiratory whoop
Crackles (aka high (fine) or low
crepitations or discontinuous (coarse), inspiratory cracking/clicking/rattling
rales) nonmusical
nonmusical, many
Pleural friction rub discontinuous low inspiratory and expiratory
repeated rhythmic sounds
Hamman's sign (or
Mediastinal discontinuous neither (heartbeat) crunching, rasping
crunch)
Continued[edit]
Rales: Small clicking, bubbling, or rattling sounds in the lungs. They are
heard when a person breathes in (inhales). They are believed to occur when
air opens closed air spaces. Rales can be further described as moist, dry,
fine, and coarse. This term is no longer much in use.
Rhonchi are coarse rattling respiratory sounds, usually caused by
secretions in bronchial airways. The sounds resemble snoring. "Rhonchi" is
the plural form of the singular word "rhonchus". Since the mid-1990s, it has
no longer been considered appropriate terminology in auscultation of the
thorax, as much confusion has been reported in the published literature which
confuses this with crepitations and wheezes, so the exact nature of this term
is unclear.
Stridor: Wheeze-like sound heard when a person breathes. Usually it is
due to a blockage of airflow in the windpipe (trachea) or in the back of the
throat.
Wheezing: High-pitched sounds produced by narrowed airways. They are
most often heard when a person breathes out (exhales). Wheezing and other
abnormal sounds can sometimes be heard without a stethoscope. [4]
Other tests of auscultation[edit]
Pectoriloquy, egophony and bronchophony are tests of auscultation. For
example, in whispered pectoriloquy the person being examined whispers -
typically a two syllable number as the clinician listens over the lung fields. The
whisper is not normally heard over the lungs, but if heard may be indicative
of pulmonary consolidation in that area. This is because sound travels differently
through denser (fluid or solid) media than the air that should normally be
predominant in lung tissue. In egophony, the person being examined continually
speaks the English long-sound "E" (/i/). The lungs are usually air filled, but if
there is an abnormal solid component due to infection, fluid, or tumor, the higher
frequencies of the "E" sound will be diminished. This changes the sound
produced, from a long "E" sound to a long "A" sound (/eɪ/).
History[edit]
In 1957, Robertson and Coope proposed the two main categories of adventitious
(added) lung sounds. Those categories were "Continuous" and "Interrupted" (or
non-continuous).[5] In 1976, the International Lung Sound Association simplified
the sub-categories as follows:
Continuous
Wheezes (>400 Hz)
Rhonchi (<200 Hz)
Discontinuous
Fine crackles
Coarse crackles[6][7]
Several sources will also refer to "medium" crackles, as a crackling sound
that seems to fall between the coarse and fine crackles. Crackles are
defined as discrete sounds that last less than 250 ms, while the
continuous sounds (rhonchi and wheezes) last approximately 250 ms.
Rhonchi are usually caused by a stricture or blockage in the upper airway.
These are different from stridor.
References[edit]
1. ^ Respiratory+sounds at the US National Library of Medicine Medical Subject
Headings (MeSH)
2. ^ Sengupta, Nandini; Sahidullah, Md; Saha, Goutam (August 2016). "Lung sound
classification using cepstral-based statistical features". Computers in Biology and
Medicine. 75 (1): 118–
129. doi:10.1016/[Link].2016.05.013. PMID 27286184.
3. ^ Bohadana, Abraham (February 20, 2014). "Fundamentals of Lung
Auscultation". New England Journal of Medicine. 370 (8): 744–
751. doi:10.1056/NEJMra1302901. PMID 24552321.
4. ^ "Breath sounds: Medline Plus". NIH. Retrieved 5 May 2015.
5. ^ Robertson, A (1957). "Rales, rhonchi, and Laennec". Lancet. 2 (6992): 417–
23. doi:10.1016/S0140-6736(57)92359-0. PMID 13464086.
6. ^ American Thoracic Society Ad Hoc Committee on Pulmonary Nomenclature
(1977). "Updated nomenclature for membership reaction". ATS News (3): 5–6.
7. ^ Loudon, R; Murphy, R (1984). "Lung Sounds". Am Rev Respir Dis. 130 (4): 663–
73. doi:10.1164/arrd.1984.130.4.663 (inactive 2021-01-15). PMID 6385790.
Mansy, H.A., Royston, T.J., Balk, R.A. et al. Med. Biol. Eng. Comput.
(2002) 40: 526. [Link]
External links[edit]
Classification D
ICD-10: R06
ICD-9-CM: 786.7
MeSH: D012135
External resources MedlinePlus: 007535
Audio Breath Sounds - Multiple case studies with audio files of lung
sounds.
R.A.L.E. Repository - sound files of breath sounds
MEDiscuss - Respiratory auscultation with audio examples
Wilkins R, Dexter J, Smith J (1984). "Survey of adventitious lung
sound terminology in case reports". Chest. 85 (4): 523–
5. doi:10.1378/chest.85.4.523. PMID 6705583.
Lehrer, Steven. Understanding Lung Sounds. Elsevier 2002.
Lung Sounds - 20 recordings and waveforms
