Is Your Asthma Causing Lung Sounds?
Medical professionals often use words that the general public doesn’t understand. Words that have become second nature to us sound like complete gibberish to others. You have more than likely heard some of these words used by either your doctor, Respiratory therapist, or nurse when describing what your lungs sound like. I wanted to take some time to explore some of the most common abnormal breath and lung sounds in asthma that we can hear with a stethoscope and often times without as well.
Types of asthma lung sounds
This is the most commonly heard breath sound associated with asthma. While not all asthmatics wheeze, the majority do. Wheezing is generally a higher-pitched whistling sound that occurs most commonly when you breathe out. This happens when the airways are narrowed due to bronchospasm and/or inflammation. When the airways are severely narrowed, wheezing can be heard when you breathe in as well. It can be heard in all lung fields or just part of the lung, such as the bases.
Stridor is a harsh, high pitched sound that comes from the upper airways. It has a very distinct sound and can almost always be heard without the use of a stethoscope. Stridor happens when there is disrupted airflow or obstruction. In kids, conditions such as croup, pertussis, epiglottitis and also choking or having something stuck in the upper airway can cause significant stridor. In adults, stridor most commonly occurs due to issues with the vocal cords with as vocal cord dysfunction (or VCD).
There are three different types of stridor: inspiratory (when you breathe in), expiratory (when you breathe out) and biphasic (when you breathe in and out). Inspiratory stridor indicates a blockage of some sort that is above the vocal cords. Expiratory stridor indicates a blockage in the trachea (windpipe). Biphasic stridor is heard when there is narrowing cartilage just below the vocal cords. In most cases, stridor can be treated and rather quickly reversed with mediations such as inhaled racemic epinephrine which helps relax and reduce swelling.
If you have ever had a lower respiratory infection, chances are you’ve experienced rhonchi. It’s that rattling, snoring sound that you can often feel inside your lungs. Rhonchi happens when there are secretions in the larger airways that literally rattle around when you breathe. These secretions can often be cleared with a good strong cough. Things that cause rhonchi include COPD, pneumonia, cystic fibrosis, bronchiectasis, and chronic bronchitis.
These two terms are used interchangeably and mean the exact same thing. Crackles are heard in the smallest airways when there is fluid in them. This is a sound that is very distinct and sounds just like you’re ripping apart two pieces of Velcro.
There are two types of crackles - fine and coarse. Coarse crackles are brief and discontinuous popping/bubbling lung sounds and are loud. Fine crackles are also brief discontinuous sound that is higher pitched than coarse crackles and sound similar to cellophane being crinkled or wood crackling on a fire. Crackles can be caused by pneumonia, pulmonary fibrosis, acute bronchitis, and bronchiectasis just to name a few.
Diminished lung sounds
This means exactly that your breath sounds can’t be heard in the bases through a stethoscope. They are tight and difficult to hear. Reduced airflow can cause diminished breath sounds which can be due to a flare-up of asthma etc.
Nothing makes a respiratory therapist more nervous than a silent chest. This is what makes our adrenaline start running on overdrive. A silent chest is just that - silent. It means your chest is so tight that no breath sounds can be heard at all with a stethoscope. While you are still breathing, it is a hurry to get medications and treatment to open those airways back up as quickly as we can.
The next time you hear your healthcare provider use any of these terms to describe your breath sounds you will have a better understanding of what exactly they mean. Your doctor will be impressed!
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