Auscultation of Velcro Crackles is Associated With Usual Interstitial Pneumonia

Abstract

Auscultation of Velcro crackles has been proposed as a key finding in physical lung examination in patients with interstitial lung diseases (ILDs), especially in idiopathic pulmonary fibrosis (IPF). However, no studies have been carried out to assess the association of Velcro crackles with other clinical variables.We evaluated a cohort of 132 patients, prospectively and consecutively included in our ILD diagnostic program at a tertiary referral center. All patients were auscultated during the physical examination. The patients were divided into 2 groups: “presence” or “nonpresence” of bilateral Velcro crackles.Of all patients assessed, 83 (63%) presented Velcro crackles in the respiratory auscultation. Patients with Velcro crackles usually had more frequently cough and dyspnea at the moment of diagnosis. Forced vital capacity (P = 0.002) and lung diffusion capacity for carbon monoxide (P = 0.04) was lower in these patients. The ILD-GAP index was higher in the group with Velcro crackles (P = 0.01). All patients with usual interstitial pneumonia (UIP) in high-resolution computed tomography and all patients with final IPF diagnosis presented Velcro crackles. In multivariate analysis, the presence of Velcro crackles was independently associated with an UIP pattern.In patients suspected of having ILD, the auscultation of Velcro crackles was associated with UIP, a possibility which must be taken into consideration in early ILD detection in primary care.

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

“…Bilateral, basal crepitations (so called "Velcro-type" cracles) identified during physical examination, especially with concomitant digital clubbing, increases the likelihood of the diagnosis [32,37]. Crepitations, although not pathognomonic, are present in about 90% of IPF patients.…”

Ongoing challenges in pulmonary fibrosis and insights from the nintedanib clinical programme

“…Automated interpretation of lung sounds is another potential measure of disease progression in IPF. "Velcro" crackles at baseline, measured by digital auscultation, are associated with the presence of UIP in patients with ILD [57]. A prospective pilot study found that longitudinal changes in lung sounds were associated with clinical deterioration in patients with IPF [58].…”

Digital Lung Auscultation: Will Early Diagnosis of Fibrotic Interstitial Lung Disease Become a Reality?

“…A subjective assessment of Velcro-like crackles bilaterally on chest auscultation predicts the presence of fibrotic ILD and usual interstitial pneumonia patterns on HRCT (10,11), and is associated with varying degrees of different ILAs (10). Hence, Velcro-like crackles may provide a rationale for investigating lung sounds to accurately identify patients with ILD, and could even be used as a screening aid.…”