Abnormal Breath Sounds

Crackles (or rales)are caused by fuid in the small airways or atelectasis.

Crackles are referred to as discontinuous sounds; they are intermittent,
nonmusical and brief. Crackles may be heard on inspiration or expiration. The
popping sounds produced are created when air is forced through respiratory
passages that are narrowed by fuid, mucus, or pus. Crackles are often
associated with infammation or infection of the small bronchi, bronchioles, and
alveoli. Crackles that don't clear after a cough may indicate pulmonary edema
or fuid in the alveoli due to heart failure or adult respiratory distress syndrome
!"#$%.
Crackles are often described as &ne, medium, and coarse.
'ine crackles are soft, high(pitched, and very brief. )ou can simulate this
sound by rolling a strand of hair between your &ngers near your ear, or by
moistening your thumb and index &nger and separating them near your ear.
Coarse crackles are somewhat louder, lower in pitch, and last longer
than &ne crackles. They have been described as sounding like opening a
*elcro fastener.
Wheezes are sounds that are heard continuously during inspiration or
expiration, or during both inspiration and expiration. They are caused by air
moving through airways narrowed by constriction or swelling of airway or
partial airway obstruction.
+hee,es that are relatively high pitched and have a shrill or s-ueaking
-uality may be referred to as sibilant rhonchi. They are often heard
continuously through both inspiration and expiration and have a musical
-uality. These whee,es occur when airways are narrowed, such as may
occur during an acute asthmatic attack.
+hee,es that are lower(pitched sounds with a snoring or moaning -uality
may be referred to as sonorous rhonchi. $ecretions in large airways, such as
occurs with bronchitis, may produce these sounds; they may clear
somewhat with coughing.
Pleural friction rubs are low(pitched, grating, or creaking sounds that occur
when infamed pleural surfaces rub together during respiration. .ore often
heard on inspiration than expiration, the pleural friction rub is easy to confuse
with a pericardial friction rub. To determine whether the sound is a pleural
friction rub or a pericardial friction rub, ask the patient to hold his breath
briefy. /f the rubbing sound continues, its a pericardial friction rub because the
infamed pericardial layers continue rubbing together with each heart beat ( a
pleural rub stops when breathing stops.
Stridor refers to a high(pitched harsh sound heard during inspiration.. $tridor
is caused by obstruction of the upper airway, is a sign of respiratory distress
and thus re-uires immediate attention.
/f adventitious sounds are heard, it is important to assess0
their loudness,
timing in the respiratory cycle,
location on the chest wall,
persistence of the pattern from breath to breath, and
whether or not the sounds clear after a cough or a few deep breaths.
o secretions from bronchitis may cause whee,es, or rhonchi%, that
clear with coughing
o crackles may be heard when atelectatic alveoli pop open after a
few deep breaths
Accessory muscles of respiration 1 muscles other than the diaphragm and
intercostal muscles that may be used for labored breathing. The
sternocleidomastoid, spinal, and neck muscles may be used as accessory
muscles of respiration; their use is a sign of an abnormal or labored breathing
pattern.
Adventitious breath sounds 1 abnormal breath sounds heard when listening
to the chest. !dventitious sounds may include crackles or rales, rhonchi or
whee,es, or pleural friction rubs. !dventitious sounds do not include sounds
produced by muscular activity in the chest wall or noises made by a
stethoscope on the chest wall.
Ataxic breathin1 also known as 2iot's breathing, is characteri,ed by
unpredictable irregularity.
Barrel chest1 a condition characteri,ed by increased anterior(posterior chest
diameter caused by increased functional residual capacity due to air trapping
from small airway collapse. ! barrel chest is fre-uently seen in patients with
chronic obstructive diseases, such as chronic bronchitis and emphysema.
Cheyne!Stokes respirations1 a breathing pattern characteri,ed by a period
of apnea, followed by gradually increasing depth and fre-uency of respirations.
Consolidation1 the replacement of air in the lungs with fuid or a mass.
Crackles1 an adventitious breath sound heard on ausculating the chest,
produced by air passing over airway secretions. ! crackle is a discontinuous
sound, as opposed to a whee,e, which is continuous. Crackles are known as
&ne or coarse and are also known as rales.
"remitus1 a vibration felt while a patient is speaking and the examiner's hand
is held against the chest.
#ntercostal retractions 1 visible use of the muscles between the ribs
intercostal muscles% to aid in breathing. /ntercostal retractions are a sign of
labored breathing.
$ussmal breathin1 a very deep gasping type of respiration associated with
severe diabetic acidosis and coma.
$yphosis1 a deformity in the normal posterior shape of the spine, producing a
humpback appearance.
%asal &arin 1 intermittent outward movements of the nostrils with each
inspiration; indicates an increase in the work needed to breathe.
Pleura1 a serous membrane covering both lungs and the walls of the thorax
and diaphragm.
Pursed lip breathin 1 partial closing of the lips to allow air to be expired
slowly; used by patients with chronic obstructive pulmonary disease.
Sibilant rhonchi1 a high pitched whee,e; musical and s-ueaky adventitious
breath sound.
Scoliosis 1 a lateral curvature of the spine.
Sonorous rhonchi !a lower pitched whee,e; snoring or moaning adventitious
breath sound.
Stridor 1 a high(pitched harsh sound heard during inspiration. $tridor is
caused by obstruction of the upper airway.
Wheeze !an adventitious or abnormal breath sound heard when listening to
the chest as a person breathes. +hee,es are continuous and musical
sounding, and usually caused by airway obstruction from swelling or
secretions. +hee,es can be high or low pitched, and are also known as
rhonchi.