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Respiratory sounds, also known as lung sounds or breath sounds, are the specific sounds generated by the movement of air through the respiratory system. [1] These may be easily audible or identified through auscultation of the respiratory system through the lung fields with a stethoscope as well as from the spectral characteristics of lung sounds. [2]
After positioning in which the patient sits upright with their arms at the side, with the chest clear of clothing, the four stages of the examination can be carried out. In order to listen to the lungs from the back the patient is asked to move their arms forward to prevent the scapulae (shoulder blades) from obstructing the upper lung fields.
Crackles are the clicking, rattling, or crackling noises that may be made by one or both lungs of a human with a respiratory disease during inhalation, and occasionally during exhalation. They are usually heard only with a stethoscope ("on auscultation"). Pulmonary crackles are abnormal breath sounds that were formerly referred to as rales. [2]
Understanding Lung Sounds 3rd edition (2002) by Steven Lehrer is a book and audio CD that guides the student through the skills of lung auscultation. It provides a complete overview of lung examination, anatomy, physiology, and pathology.
Breath sounds are bronchial; Possible medium, late, or pan-inspiratory crackles; Vocal resonance is increased. Here, the patient's voice (or whisper, as in whispered pectoriloquy) can be heard more clearly when there is consolidation, as opposed to the healthy lung where speech sounds muffled. A pleural rub may be present. [4]
Percussion of the lung fields for dullness or hyper-resonance. Auscultation (with a stethoscope) of the lung fields for diminished or unusual breath sounds. Rales or rhonchi heard over lung fields with a stethoscope. As many heart diseases can give pulmonary signs, [20] a thorough cardiac investigation is usually included.
Lung sounds are usually clear yet diminished due to decreased base lung capacity. [16] Many scales have been developed to determine the degree of deformity in the chest wall. Most of these are variants on the distance between the sternum and the spine.
Upon physical examination, breath sounds (heard with a stethoscope) may be diminished on the affected side, partly because air in the pleural space dampens the transmission of sound. Measures of the conduction of vocal vibrations to the surface of the chest may be altered.