The main breathing abnormalities are:



The main breathing abnormalities are:

• Crackles

• Wheezes

• Pleural Rub

Crackles:

Crackles (rales) are caused by excessive fluid in the airways. It is caused by either an exudate or a transduate. Exduate is due to lung infection e.g pneumonia while transduate such as congestive heart failure.[1] A crackle occurs when a small airways pop’s open during inspiration after collapsing due to fluid or lack of aeration during expiration. [2] Crackles are much more common in inspiratory than in expiratory.

Crackles are high-pitched and discontinuous. They sound like hair being rubbed together. [3] There are three different types; fine, medium and coarse.

• Fine are typically late inspiratory and coarse are usually early inspiratory

• Fine crackles are high pitched, very brief and soft. It sounds like rolling a strand of hair between two fingers. Fine crackles could suggest an interstitial process; e.g pulmonary fibrosis, congestive heart failure.

• Coarse crackles are louder, more low pitched and longer lasting. They sound like the separation of Velcro. Coarse crackles could suggest an airway disease, chronic bronchitis. [4]

Wheezes:

Wheezes are an expiratory sound caused by forced airflow through collapsed airways. Due to the collapsed or abnormally narrow airway, the velocity of air in the lungs is elevated. [1] Wheezes are continuous high pitched hissing sounds. They are heard more frequently on expiration than on inspiration. If they are monophonic it us due to an obstruction in one airway only but if they are polyphonic than the cause is a more general obstruction of airways. [5] Where the wheeze occurs in the respiratory cycle depends on the obstructions location, [6] if wheezing occurs in the expiratory phase of respiration it is usually connected to broncholiar disease. [7] If the wheezing is in the inspiratory phase, it is an indicator of stiff stenosis whose causes range from tumours to scarring. One of the main causes of wheezing is asthma, [7] other causes could be pulmonary edema, interstitial lung disease and chronic bronchitis.

Pleural Rub:

Pleural Rub produces a creaking or brushing sound. These occur when the pleural surfaces are inflamed and as a result rub against one another. They are heard during both inspiratory and expiratory phases of the lung cycle and can be both continuous and discontinuous. Pleural rub can suggest pneumothorax or pleural effusion.

.

|Sounds: |Sounds like: |Caused by: |Could be cause of: |

|Scattered Wet Crackles |typically inspiratory |Excessive Fluid Within the |Pneumonia |

| |particularly wet sounding |Lungs |Other lung infections |

|Crackles |Hair being rubbed together or |Small airways open during |ARDS |

| |Velcro opening |inspiration and collapse during|asthma |

| |They are discontinuous, |expiration |bronchiectasis |

| |non-musical and brief | |chronic bronchitis |

| | | |consolidation |

| | | |early CHF |

| | | |interstitial lung disease |

| | | |pulmonary edema |

|Wheezes |Usually heard on expiration. |forced airflow through |Asthma |

| |continuous, |abnormally collapsed airways |CHF |

| |high pitched, hissing sounds |with residual trapping of air |chronic bronchitis |

| | | |COPD |

| | | |pulmonary edema |

|Pleural Rub |creaking or brushing sounds. |pleural surfaces are inflamed |pleural effusion |

| |Can be continuous or |or roughened and rub against |pneumothorax |

| |discontinuous |each other | |

[1] Auscultation Assistant

[2] RL Wilkins, JR Dexter and JR Smith (1984). "Survey of adventitious lung sound terminology in case reports". Chest 85: 523–525. doi:10.1378/chest.85.4.523.

[3] Lung and Infectious Diseases RL Wilkins, JR Dexter and JR Smith (1984). "Survey of adventitious lung sound terminology in case reports". Chest 85: 523–525. doi:10.1378/chest.85.4.523.

[4] Forgacs P (1978). "The functional basis of pulmonary sounds" (PDF). Chest 73 (3): 399–405. doi:10.1378/chest.73.3.399. PMID 630938. . 

[5]

[6] ^ Shim CS, Williams MH (May 1983). "Relationship of wheezing to the severity of obstruction in asthma". Arch Intern Med. 143 (5): 890–2. doi:10.1001/archinte.143.5.890. PMID 6679232. 

[7] ^ Baughman RP, Loudon RG (Nov 1984). "Quantitation of wheezing in acute asthma" ([dead link] – Scholar search). Chest 86 (5): 718–22. doi:10.1378/chest.86.5.718. PMID 6488909. . 

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