Coarse Lung Sounds and Their Management

Creator: Dr. Sreejaya. K. K
Published: 2023-04-12T17:02:25

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The lung produces different categories of sounds in different pathologies. This article will focus on coarse lung sounds and their management.

Written by

Dr. Sreejaya. K. K

Medically reviewed by

Dr. Kaushal Bhavsar

April 12, 2023

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Contents

What are Breath Sounds?
What Are the Coarse Lung Sounds?
How to Diagnose the Cause of Abnormal Breathing?
What Are the Management Strategies for Coarse Breath Sounds?

Introduction

The lung produces different categories of sound in healthy conditions and pathologies. The physician can appreciate these sounds during an auscultatory pulmonary examination, which is useful in determining the underlying pathologies.

What are Breath Sounds?

Normal breath sounds are heard through the chest walls using a stethoscope in a healthy individual. Breath sounds include bronchial, vesicular, or bronchovesicular sounds. Based on the anatomical properties of the area, the breath sounds have different acoustics. Bronchial sounds are high-pitched sounds normally heard in the tracheobronchial tree; they are also called tubular sounds. When they are heard in the lung peripheries, the existence of underlying pathology is evaluated because it usually occurs in consolidated lungs or solidification of lungs. Similarly, the vesicular sounds are soft, low-pitched sounds heard from the lung parenchyma from the chest peripheries. When heard in other areas of the lungs, it is considered abnormal.

Sounds heard in addition to the expected normal breath sounds are called adventitious sounds. The most commonly heard adventitious sounds are:

Wheeze.
Ronchi.
Crackles.

Wheeze and rhonchi are continuous sounds with a duration greater than 250 ms, similar to the whirring of a fan. In contrast, crackles are counted as discrete interrupted units with a duration of less than 25 ms, with sounds similar to a marble dropping on the floor. Crackles are produced on inspiration when the airways snap open. The snapping of large airways generates coarse crackles, and that of small airways produces fine crackles.

The fluttering of the airways generates wheezes and rhonchi. The movement of air through a narrow constricted airway produces a musical sound called wheeze, and the same phenomenon, when in a larger airway that is constricted, results in a Ronchi.

The other sounds include stridor and rub. Stridor is produced in the upper airway, a high-pitched sound more intense in the neck than in the chest. The rub is generated when the pleura rub against each other, producing a grating sound. Rubs are louder than the other lung suns because of their proximity to the chest wall.

What Are the Coarse Lung Sounds?

Coarse sounds are harsh low, pitched sounds that have a rough tone. The pathological sounds heard from the lungs may be coarse or high-pitched. The coarse sounds are:

Rhonchi.
Coarse crackles.
Pleural rub.

Rhonchi:

Unlike crackles, rhonchi are continuous sounds heard in a pathological lung. It has a low pitch compared to wheezing and sounds similar to snoring heard through a stethoscope. The fluttering of air through a large but constricted airway results in rhonchi; there may be the presence of inflamed tissue as well as fluid in these airways. They are heard in chronic obstructive pulmonary disease (COPD).

Coarse Crackles:

During inspiration, the large airways snap open in certain pathological conditions, producing a deeper-pitched, coarse interrupted sound. These are referred to as coarse crackles. They are also known as rales. Coarse crackles are usually heard in people with chronic obstructive lung diseases, which are associated with the following:

Chronic bronchitis.
Chronic asthma.
Emphysema.
Bronchiectasis.
Cystic fibrosis.

Pulmonary edema may be associated with end-stage renal disease or congestive heart failure.

Pleural Rub:

The thin membrane covering the lungs and lung cavity is the pleurae. They slide over each other smoothly to regulate breathing. However, the pleural friction rub occurs in certain disease conditions, producing explosive sounds heard through the stethoscope during inspiration and expiration. It indicates an interruption between the membranes. This phenomenon occurs in chronic obstructive pulmonary diseases due to inflammation of the pleurae.

How to Diagnose the Cause of Abnormal Breathing?

Auscultation is the age-old method to identify breath sounds. Using a stethoscope, a physician listens to the nature of airflow through the respiratory tract and lungs. Some physicians use advanced technologies like computerized lung sound analysis, which has more accurate interpretations.

A thorough personal and medical history is taken, and other investigative tests like blood tests to check for the signs of the potential causes and imaging tests like plain film chest X-ray and CT (computed tomography) scan to observe the respiratory structures.

In the presence of infection, a sputum test is performed, and a pulmonary function test is performed to determine the presence of any blockage or damage to the airways. The test measures the amount of air inhaled or exhaled by a person and assesses whether the breathing function is normal.

What Are the Management Strategies for Coarse Breath Sounds?

The treatment plan for abnormal breath sounds is determined by their underlying causes and the severity of symptoms. If an infection is present antibiotic therapy along with breathing treatment will help in opening the airways. In severe cases like a serious infection, fluid in the lungs, marked difficulty in breathing, or severe blockage of airways, hospital admission and proper monitoring is necessary. In chronic conditions, regular medication and breathing treatment are required. For instance, asthmatic patients must always carry their corticosteroid inhaler in case of a sudden asthmatic attack.

Abnormal breathing sounds should not be ignored and taken immediate medical attention. Often it indicates common treatable disorders. However, some cases may indicate severe underlying disease. As discussed above, the most common cause of coarse lung sounds is an obstructive lung disease. Several treatments are available to control the signs and symptoms of the disease, and They are as follows:

Quitting Smoking:

The best way to improve lung health for a smoker with obstructive lung disease. Though it is difficult, it is possible through medication and psychological approaches.

Inhalers:

Inhalers are medications used to open the airways and facilitate breathing. They may be short-acting beta-two agonists. They provide quick relief in case of worsening symptoms and reduce the frequency of exacerbations.

Nebulizers:

For patients unable to use inhalers, a nebulizer is used. It converts medications into a fine mist inhaled using a mask or a mouthpiece.

Corticosteroids:

They are used along with an inhaler and can be used to control symptom flare-ups.

Phosphodiesterase -4 Inhibitors:

Oral medications are used to reduce lung inflammation and symptom flares.

Mucolytics:

Obstructive lung diseases create excess mucus in the lungs, which can be dissolved using mucolytics, making breathing easier.

Supplemental oxygen:

Getting enough oxygen when the air passages are narrowed down or obstructed is difficult. Providing supplemental oxygen through masks or nose prongs can increase the oxygen available for the lungs and the body.

Conclusion

Listening to different sounds from the lungs will help identify, to a large extent, what is happening inside the body. Certain sounds are normal breath sounds heard in healthy individuals, while some sounds depending on their nature, may indicate a narrowing of the airways, obstructions, congestions, solidifications, etc. A proper preliminary chest examination followed by investigative tests will help identify the potential disease condition accurately and determine an ideal treatment plan.

Frequently Asked Questions

1. What Does the Presence of Coarse Lung Sounds Indicate?

Coarse lung sounds manifest as low-pitched, rattling noises and can indicate signs of underlying medical conditions. These sounds can be classified into three distinct types:
- Ronchi, characterized by a low-pitched resonance resembling snoring, is often present in chronic obstructive pulmonary disease (COPD) in which air passage is impaired.
- Coarse crackles, with a deeper pitch, may be discernible in individuals with chronic asthma or chronic bronchitis (inflammation of air passages).
- Pleural rub, on the other hand, occurs when the lung membranes glide against each other, resulting in explosive sounds.

2. What Is an Alternative Term for Coarse Lung Sounds?

No alternative term exists to describe coarse lung sounds. These auditory manifestations, characterized by their rugged quality, serve as pathological indicators for specific lung conditions. Among these distinct coarse sounds, one can encounter Ronchi, presenting as low-pitched, continuous tones, coarse crackles, also known as rales, which produce deeper, more profound sounds, and pleural rub, a distinctive dry rubbing sound emanating from the lung membranes as they interact.

3. Are Coarse Lung Sounds Considered Normal?

No, coarse lung sounds are not normal. They are atypical auditory signals, serving as precise indicators of underlying lung ailments or respiratory challenges. They span the spectrum from acute to chronic conditions, with causes as diverse as pneumonia, pulmonary edema, bronchiectasis, or bronchitis. To dismiss these sounds would be unwise; instead, one should promptly seek the counsel and expertise of a healthcare professional for a comprehensive evaluation and necessary intervention.

4. Is It Possible to Detect Coarse Crackles

Indeed, coarse crackles can be discerned through a chest examination facilitated by a stethoscope. These peculiar sounds manifest as low-pitched or bubbling tones, predominantly noticeable during the inhalation phase of respiration. Additionally, the healthcare practitioner should diligently evaluate the sounds originating from the opposite lung to gauge symmetry. Further diagnostic steps may involve utilizing X-rays, pulmonary function tests, or CT (computed tomography) scans to comprehensively understand the condition.

5. Do Coarse Crackles Dissipate When Coughing?

Coarse crackles may or may not dissipate when a cough is initiated. For instance, crackles linked to the presence of airway secretions might experience a temporary reduction or complete clearance upon coughing. Conversely, crackles stemming from lung irregularities such as pulmonary fibrosis or interstitial lung disease tend to persist despite coughing efforts.

6. How Can One Manage or Address Coarse Crackles?

The management of coarse crackles is contingent upon the root cause, and various approaches come into play:
- Thorough physical and medical assessments are conducted to pinpoint the underlying condition.
- Antibiotics are administered when bacterial infections are detected, while anti-inflammatory medications are employed for conditions like interstitial lung disease or pleuritis.
- Respiratory therapy alleviates mucus buildup in cases of COPD or bronchiectasis, aiding in airway clearance. Additionally, healthcare providers may prescribe cough suppressants or expectorants.
- Supplemental oxygen may be introduced to enhance blood oxygenation.
- Lifestyle modifications include adopting a healthy diet, embarking on smoking cessation programs, and minimizing exposure to environmental pollutants and allergens.

7. What Distinguishes Crackles From Coarse Lung Sounds?

Crackles and coarse lung sounds serve as auditory signals that deviate from the norm, offering clues to underlying pathological conditions. Crackles, characterized by fine, intermittent popping noises, can manifest during inhalation and exhalation. They often correlate with the sudden opening or popping of small airways, resulting in either fine crackles or coarse crackles. In contrast, coarse crackles produce deeper, intermittent sounds, marking a distinctive variation in their acoustic profile.

8. What Sets Coarse Sounds Apart From Rhonchi?

Both coarse sounds and Ronchi are atypical lung sounds, signifying underlying abnormalities. Coarse crackles, also known as rales, emit low-pitched, sporadic sounds often linked to mucus secretions or excess fluid in the lung airways. In contrast, Ronchi maintains a continuous low-pitched tone characterized by a wheezing or snoring quality. These persistent sounds arise from airway obstructions or constrictions.

9. Can Lung Sounds Be Assessed Without a Stethoscope?

Evaluating lung sounds without a stethoscope presents a formidable challenge, as this instrument plays a pivotal role in the comprehensive assessment of lung and heart sounds. While alternative approaches, such as direct ear-to-chest or ear-to-back auscultation and keen attention to cough sounds, provide some preliminary insights, they must be more reliable tools for precise and thorough evaluation.

10. How Is It Described When Lung Sounds Are Moist?

When perceived through a stethoscope, moist sounds exhibit a distinct wet or gurgling quality, typically stemming from fluid or mucus within the lung airways. This category of sounds can be further classified as moist crackles, encompassing both coarse bubbling and fine crackling, often observed in conditions like pulmonary edema or pneumonia. Rales, another variant of moist lung sounds, manifest as discontinuous, revealing the presence of secretions within the lungs.

11. What Is the Medical Terminology for Frictional Lung Sounds?

In medical terminology, frictional lung sounds are referred to as "pleural friction rub" or simply "pleural rub." These sounds are characterized by a dry, rubbing, or grating noise that arises when the lung membranes undergo friction as they glide against each other. This phenomenon is often associated with conditions like pleuritis, characterized by inflammation. Also, pleural rub may manifest in infections, lung trauma, or pulmonary embolism.

12. Is the Presence of Coarse Crackles Common in COPD?

Indeed, coarse crackles are not a common hallmark of COPD. Instead, COPD tends to be associated with distinct lung sounds, such as wheezing, which presents as a high-pitched sound resulting from the narrowing of airways. In advanced stages of COPD, diminished breath sounds and an extended respiratory phase may also be observed. Conversely, coarse crackles find their associations in conditions like pulmonary edema, pneumonia, and bronchitis, offering valuable diagnostic clues.

13. Does Pneumonia Typically Result in Coarse or Fine Crackles?

The presence of pneumonia can give rise to a range of crackling sounds, both coarse and fine, depending on the severity of the condition. Fine crackles become apparent in the initial stages of pneumonia when the infection impacts the smaller airways. These fine crackles are characterized by a high-pitched, bubble-like popping sound. As pneumonia advances, a transition to coarse crackles occurs, marked by lower-pitched sounds, providing clinicians with valuable insights into the progression of the disease.

14. How Is Coarse Breathing Defined?

Coarse breathing, characterized by loud and harsh respiratory sounds, indicates abnormal respiration. Coarse breathing can manifest as coarse crackles, which are low-pitched and often associated with infection, inflammation, or mucus within the airways. Another form of noisy breathing emerges when there is an obstruction within the airways, as seen in conditions like asthma or severe bronchitis. Additionally, harsh breathing sounds may be evident in conditions such as croup (a respiratory infection that affects children primarily) or when there is an obstruction in the airway, each contributing to the diverse tapestry of respiratory abnormalities.

Sources

Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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