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Lung Sounds 5
Lung Sounds 5
WHEEZE
MARCIAL JOURNAL
● Higher pitch and greater intensity than rhonchi ● Most easily recognized adventitious sound
● Frequency ranges from 100-1000 Hz ● High-pitched musical sound
● Wave form consists of many sine waves superimposed upon ● Long duration (more than 100 msec): Can be discerned by human ear
one another ● Can be inspiratory, expiratory or biphasic
→ Each of these individual waves represents a fundamental ● Sound Analysis: Sinusoidal oscillations with sound energy in the
note and its harmonically related overtones range of 100 to 1000 Hz and with harmonics that exceed 1000 Hz on
→ Gives it a musical or whistling quality occasion
● Representation in Lung Auscultogram: ● Formed in the branches between the 2nd and 7th generations of the
→ Sine wave with smooth edges airway tree by the coupled oscillation of gas and airway walls that have
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▪ Thickness emphasizes louder sounds
▪ Pitch is approximated by the angles
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been narrowed to the point of apposition by a variety of mechanical
forces
AUSCULTOGRAM ● 2 Principles:
→ Although wheezes are always associated with airflow limitation,
airflow can be limited in the absence of wheezes
→ Pitch of an individual wheeze is determined by:
▪ Thickness of the airway wall
▪ Bending Stiffness
▪ Longitudinal Tension
● NOT pathognomonic of any particular disease
→ Can be heard in obstructive airway diseases (COPD and asthma)
wherein wheezes can be heard all over the chest
● Localized Wheeze: Related to a local phenomenon
→ Can be due to:
▪ Obstruction by a foreign body
Figure 7. Lung Auscultogram of a Wheeze ▪ Mucous plug
▪ Tumor
→ Patients with this type of wheeze often receive a misdiagnosis of
Degree of airflow limitation proportional to number of airways “difficult-to-treat asthma”
generating the wheezes ● Wheezes may be absent in patients with severe airway obstruction
→ Model cited above predicts that the more severe the obstruction, the
lower the likelihood of wheeze (absent if airflow is too low).
→ Example is a severe asthma attack
▪ Condition in which the lower respiratory flows cannot provide the
energy necessary to generate wheezes (or any sounds)
▪ Normal breath sound is also severely reduced or even absent
▪ Creating a clinical picture known as “silent lung”
▪ As the obstruction is relieved and airflow increases, both the
wheeze and normal breath sounds reappear