The highs and lows of wheezing: A review of the most popular adventitious lung sound

Pasterkamp, Hans

doi:10.1002/ppul.23930

Cited by 26 publications

(18 citation statements)

References 106 publications

(155 reference statements)

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“…The high observer ability to identify the wheezes and the stridor was not surprising. By their long duration (typically >80-100 ms) tonal quality, and relatively high amplitude [12][13][14][15] adventitious musical sounds are easier to recognise by the human ear than non-musical sounds of shorter duration (typically 5-15 ms) and lower amplitude like, for instance, the crackles. 16 17 Several factors could have hampered the observers' auscultatory skill.…”

Section: Discussionmentioning

confidence: 99%

Influence of observer preferences and auscultatory skill on the choice of terms to describe lung sounds: a survey of staff physicians, residents and medical students

et al. 2020

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BackgroundIn contrast with the technical progress of the stethoscope, lung sound terminology has remained confused, weakening the usefulness of auscultation. We examined how observer preferences regarding terminology and auscultatory skill influenced the choice of terms used to describe lung sounds.MethodsThirty-one staff physicians (SP), 65 residents (R) and 47 medical students (MS) spontaneously described the audio recordings of 5 lung sounds classified acoustically as: (1) normal breath sound; (2) wheezes; (3) crackles; (4) stridor and (5) pleural friction rub. A rating was considered correct if a correct term or synonym was used to describe it (term use ascribed to preference). The use of any incorrect terms was ascribed to deficient auscultatory skill.ResultsRates of correct sound identification were: (i) normal breath sound: SP=21.4%; R=11.6%; MS=17.1%; (ii) wheezes: SP=82.8%; R=85.2%; MS=86.4%; (iii) crackles: SP=63%; R=68.5%; MS=70.7%; (iv) stridor: SP=92.8%; R=90%; MS=72.1% and (v) pleural friction rub: SP=35.7%; R=6.2%; MS=3.2%. The 3 groups used 66 descriptive terms: 17 were ascribed to preferences regarding terminology, and 49 to deficient auscultatory skill. Three-group agreement on use of a term occurred on 107 occasions: 70 involved correct terms (65.4%) and 37 (34.6%) incorrect ones. Rate of use of recommended terms, rather than accepted synonyms, was 100% for the wheezes and the stridor, 55% for the normal breath sound, 22% for the crackles and 14% for the pleural friction rub.ConclusionsThe observers’ ability to describe lung sounds was high for the wheezes and the stridor, fair for the crackles and poor for the normal breath sound and the pleural friction rub. Lack of auscultatory skill largely surpassed observer preference as a factor determining the choice of terminology. Wide dissemination of educational programs on lung auscultation (eg, self-learning via computer-assisted learning tools) is urgently needed to promote use of standardised lung sound terminology.

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Section: Discussionmentioning

confidence: 99%

Influence of observer preferences and auscultatory skill on the choice of terms to describe lung sounds: a survey of staff physicians, residents and medical students

et al. 2020

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“…In addition, the various phenotypes of asthma may have different clinical presentations. Wheezing is not unique to asthma as it can occur as a result of bronchial obstruction from a number of reasons ( 34 ), and children tend to wheeze more than adults ( 35 ). Wheezing is a common manifestation of viral infections in children ( 36 – 38 ), but not all children that wheeze develop asthma ( 35 , 39 ).…”

Section: Asthmamentioning

confidence: 99%

“…Wheezing is not unique to asthma as it can occur as a result of bronchial obstruction from a number of reasons ( 34 ), and children tend to wheeze more than adults ( 35 ). Wheezing is a common manifestation of viral infections in children ( 36 – 38 ), but not all children that wheeze develop asthma ( 35 , 39 ). A reliable asthma diagnosis must be meticulously made (often by a pulmonologist) using measures of lung function and full history of characteristic symptom patterns confirmed by bronchodilator reversibility testing ( 23 ).…”

Section: Asthmamentioning

confidence: 99%

Influenza in Asthmatics: For Better or for Worse?

2018

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Asthma and influenza are two pathologic conditions of the respiratory tract that affect millions worldwide. Influenza virus of the 2009 pandemic was highly transmissible and caused severe respiratory disease in young and middle-aged individuals. Asthma was discovered to be an underlying co-morbidity that led to hospitalizations during this influenza pandemic albeit with less severe outcomes. However, animal studies that investigated the relationship between allergic inflammation and pandemic (p)H1N1 infection, showed that while characteristics of allergic airways disease were exacerbated by this virus, governing immune responses that cause exacerbations may actually protect the host from severe outcomes associated with influenza. To better understand the relationship between asthma and severe influenza during the last pandemic, we conducted a systematic literature review of reports on hospitalized patients with asthma as a co-morbid condition during the pH1N1 season. Herein, we report that numerous other underlying conditions, such as cardiovascular, neurologic, and metabolic diseases may have been underplayed as major drivers of severe influenza during the 2009 pandemic. This review synopses, (1) asthma and influenza independently, (2) epidemiologic data surrounding asthma during the 2009 influenza pandemic, and (3) recent advances in our understanding of allergic host–pathogen interactions in the context of allergic airways disease and influenza in mouse models. Our goal is to showcase possible immunological benefits of allergic airways inflammation as countermeasures for influenza virus infections as a learning tool to discover novel pathways that can enhance our ability to hinder influenza virus replication and host pathology induced thereof.

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“…Lung auscultation has shown to be useful in diagnosing various respiratory disorders. Adventitious lung sounds (ALS) such as wheezes and crackles are associated with common diseases like asthma [3], chronic obstructive pulmonary disease (COPD) [4, 5], interstitial lung disease [6], bronchiectasis [7], heart failure [8] and pneumonia [9–11]. Positive findings during auscultation influence clinical decisions such as the rate of antibiotic prescriptions [12, 13] and referrals to specialist care [14].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and clinical associations of wheezes and crackles in the general population: the Tromsø study

et al. 2019

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Background Wheezes and crackles are well-known signs of lung diseases, but can also be heard in apparently healthy adults. However, their prevalence in a general population has been sparsely described. The objective of this study was to determine the prevalence of wheezes and crackles in a large general adult population and explore associations with self-reported disease, smoking status and lung function. Methods We recorded lung sounds in 4033 individuals 40 years or older and collected information on self-reported disease. Pulse oximetry and spirometry were carried out. We estimated age-standardized prevalence of wheezes and crackles and associations between wheezes and crackles and variables of interest were analyzed with univariable and multivariable logistic regressions. Results Twenty-eight percent of individuals had wheezes or crackles. The age-standardized prevalence of wheezes was 18.6% in women and 15.3% in men, and of crackles, 10.8 and 9.4%, respectively. Wheezes were mostly found during expiration and crackles during inspiration. Significant predictors of expiratory wheezes in multivariable analyses were age (10 years increase - OR 1.18, 95%CI 1.09–1.30), female gender (1.45, 1.2–1.8), self-reported asthma (1.36, 1.00–1.83), and current smoking (1.70, 1.28–2.23). The most important predictors of inspiratory crackles were age (1.76, 1.57–1.99), current smoking, (1.94, 1.40–2.69), mMRC ≥2 (1.79, 1.18–2.65), SpO2 (0.88, 0.81–0.96), and FEV1 Z-score (0.86, 0.77–0.95). Conclusions Nearly over a quarter of adults present adventitious lung sounds on auscultation. Age was the most important predictor of adventitious sounds, particularly crackles. The adventitious sounds were also associated with self-reported disease, current smoking and measures of lung function. The presence of findings in two or more auscultation sites was associated with a higher risk of decreased lung function than solitary findings.

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The highs and lows of wheezing: A review of the most popular adventitious lung sound

Cited by 26 publications

References 106 publications

Influence of observer preferences and auscultatory skill on the choice of terms to describe lung sounds: a survey of staff physicians, residents and medical students

Influence of observer preferences and auscultatory skill on the choice of terms to describe lung sounds: a survey of staff physicians, residents and medical students

Influenza in Asthmatics: For Better or for Worse?

Prevalence and clinical associations of wheezes and crackles in the general population: the Tromsø study

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