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  • Lung Sounds 5

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    Kyle Latayan
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    This document summarizes wheezes, which are abnormal breath sounds characterized by high-pitched musical sounds with a long duration. Wheezing is caused by vibrations of air flowing through narrowed airways. The pitch of wheezes depends on the degree of airway narrowing, with higher pitches indicating tighter obstruction. Wheezing occurs in the airways between the second and seventh generations due to coupled gas and airway wall oscillations in narrowed airways. The presence of wheezes indicates airflow limitation, but wheezes may be absent in cases of severe obstruction where airflow is too low to generate the sounds.

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    This document summarizes wheezes, which are abnormal breath sounds characterized by high-pitched musical sounds with a long duration. Wheezing is caused by vibrations of air flowing through narrowed airways. The pitch of wheezes depends on the degree of airway narrowing, with higher pitches indicating tighter obstruction. Wheezing occurs in the airways between the second and seventh generations due to coupled gas and airway wall oscillations in narrowed airways. The presence of wheezes indicates airflow limitation, but wheezes may be absent in cases of severe obstruction where airflow is too low to generate the sounds.

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    © All Rights Reserved
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    48 views1 page

    Lung Sounds 5

    Uploaded by

    Kyle Latayan
    This document summarizes wheezes, which are abnormal breath sounds characterized by high-pitched musical sounds with a long duration. Wheezing is caused by vibrations of air flowing through narrowed airways. The pitch of wheezes depends on the degree of airway narrowing, with higher pitches indicating tighter obstruction. Wheezing occurs in the airways between the second and seventh generations due to coupled gas and airway wall oscillations in narrowed airways. The presence of wheezes indicates airflow limitation, but wheezes may be absent in cases of severe obstruction where airflow is too low to generate the sounds.

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    of 1

    B.

    ABNORMAL (ADVENTITOUS) BREATH SOUNDS

    Abnormal Breath Sounds


    ● Divided into: (Marcial)
    → Continuous Sounds (CALS)
    ▪ Lasting longer than 250 milliseconds
    − Wheezes
    − Ronchi
    ▪ Caused by vibrations of air flowing rapidly through a narrowed airway
    ▪ Pitch of Sound:
    − Related to the extent of the airway narrowing
    − HIGHER pitch = TIGHTER airway obstruction (narrower)
    − Depends on frequency of the vibrations determined by the airflow rate and the mechanical properties of the affected bronchus
    → Discontinuous Sounds (DALS)
    ▪ 250 milliseconds or less in duration
    − Coarse Crackles
    − Fine Crackles
    ▪ Explosive, sharp, discrete bursts of interrupted sounds
    ▪ Can be distinguished by the human ear

    ● Divided into: (Journal)


    → Musical – stridor, wheeze, rhonchus
    → Non-musical – crackles, pleural friction rub, squawk

    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

    -
    ▪ Thickness emphasizes louder sounds
    ▪ Pitch is approximated by the angles
    - >
    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

    MED.3.08 TBL: Lung Sounds 5 of 26

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