Breathe in, breathe out; other than the whoosh of air, no other sounds should be heard. Anything more than the regular breath sound is considered abnormal. When altered sounds can be heard, there is usually a condition harming the lungs or airway. From obstructions to germs, different sounds can give an idea of what is going on in the airways. The use of a stethoscope is necessary to hear some of these tiny sounds. More than one adventitious sound can be present based on what is causing the altered respiration symptoms.
Rales
Rales are also known as crackles. This is small bubbling or clicking heard with a stethoscope, it is much like the static sound heard on the radio. The sound is heard with breathing in or out and is not always a continuous sound. This is usually caused by fluid or other secretions in the lungs and is produced by air opening closed spaces and passing over the secretions. Hearing crackles or rales in the lungs indicates some type of inflammation or infection that is currently in the smaller airways of the lungs: the small bronchi, bronchioles and alveoli. Rales are further broken down into moist, dry, fine and coarse. Fine crackles, according to RNceus.com, a website that helps train registered nurses, are soft sounds similar to the sound produced when crunching or rolling several strands of hair near the ear. Coarse crackles are similar to the sound of Velcro being pulled apart.
Rhonchi/Wheezing
Rhonchi is heard continuously during inhalation or exhalation. Sometimes the terms wheezing and rhonchi are used interchangeably. The National Institutes of Health refer to wheezing as a more specific high pitched sound heard with or without a stethoscope heard upon exhalation. This sound is usually a high pitched wheeze or squeak heard during an asthma attack. During an attack the airways close up during exhalation, making it harder to breathe out. This high pitched sound is also classified as sibilant rhonchi. Rhonchi can also take on a deeper tone called sonorous rhonchi that is similar to the sound of snoring. These sounds are more common during bronchitis or other infections of the lower airways. RNceus.com states that these sounds may clear up with coughing as secretions, like mucus, in the lungs are responsible for this problem.
Stridor
Stridor is a harsh and high-pitched sound heard when breathing in. It is not necessary to use a stethoscope to hear this sound. Usually this sound is indicative of an upper airway obstruction and will need immediate attention. This blockage leads to respiratory distress and needs to be monitored very carefully, if the obstruction cannot be removed. The American Academy of Orthopaedic Surgeons states this is a common sound heard in children with an infection called croup.
Pleural Friction Rubs
This breath sound is not as common as the first three. The lungs are each contained in a pleural sac that help lubricate the organs and allow them to move with in the body cavities. Occasionally this sac can become inflamed and rub against the body cavity or nearby structures, causing a low pitched creaking, grating or rubbing sound heard more often with inhalation than expiration.
Pericardium Friction Rubs
This friction rub is similar to that of the pleural rub in terms of sound, just not location. The heart is encased in the peridardium. The pericardium can become inflammed and rub against other organs or near by tissues. RNHceus.com indicates the best way to determine whether a sound is a pleural rub or a pericardial rub is to ask the person to hold his breath. If the creak is still heard while the breath is held, it means it's the pericardium rubbing during heart beats.
References
- National Institutes of Health: Airway sounds
- RNceus.com: Adventitious Breathing
- "Emergency Care and Transportation of the Sick and Injured -- ninth edition;" The American Academy of Orthopaedic Surgeons; 2005.
