• Respiratory Auscultation

    Abnormal Breath Sounds

    Absent or Decreased Breath Sounds


    There are a number of common uses for absent or decreased breath sounds, including:
    • Asthma: decreased breath sounds
    • Atelectasis (Collapse): If the bronchial obstruction persists, breath sounds are absent unless the atelectasis occurs in the upper lobes when adjacent tracheal sounds may be audible.
    • Fibrosis: decreased breath sounds, unless fibrosis occurs in upper lobes when adjacent tracheal sounds may be audible
    • Emphysema: decreased breath sounds
    • Pleural Effusion: decreased or absent breath sounds. If the effusion is large, bronchial sounds may be heard at the upper level of fluid.
    • Pneumothorax: decreased or absent breath sounds
    • ARDS: decreased breath sounds in late stages

    Vesicular breath sounds may also be softer if the patient is
    • frail,
    • elderly,
    • obese, or
    • very muscular

    Listen to the audio of a diminished vesicular breath sound:



    Harsh Vesicular Breath Sounds


    Vesicular breath sounds may be harsher and slightly longer if there is
    • rapid deep ventilation (eg post-exercise) or
    • in persons with thinner chest walls.

    Listen to the audio of harsh vesicular breath sound:



    Bronchovesicular Breath Sounds


    These are breath sounds of intermediate intensity and pitch. The inspiratory and expiratory sounds are equal in length. They are best heard -
    • in the 1st and 2nd intercostal space (anterior chest) and
    • between the sapulae (posterior chest) - i.e., over the mainstem bronchi.

    Listen to the audio of bronchovesicular breath sound:



    Bronchial Breath Sounds


    Bronchial breath sounds are usually loud, high-pitched and sound close to the stethoscope. The following are the features of bronchial breath sounds:
    1. character is HOLLOW.
    2. there is a gap between the inspiratory and expiratory phases of respiration
    3. the expiratory sounds are equal in length to inspiratory sounds.

    If these sounds are heard anywhere other than over the manubrium, they indicate an abnormality (these sounds are also heard over the trachea, but trachea is NOT a standard area for auscultation).

    These are the common causes of bronchial breathing:
    • Consolidation
    • Cavity
    • Upper level of pleural effusion
    • Upper lobe fibrosis
    • Upper lobe collapse
    • bronchopleural fistula

    NOTE:

    The ideal method to recognize bronchial breathing while auscultating is to look for
    the hollow character of the sound. Then confirm that it is indeed bronchial breathing by looking for the gap between inspiration and expiration and the equality of these two phases of respiration.

    Do not try to identify the bronchial sound by looking for the gap or equality of phases! You will spend a lot of time and also miss the bronchial often. Look for the hollow character. You will rarely go wrong.

    Listen to the audio of bronchial breath sound:



    The
    mp3 audio clips used in this article can be downloaded from our downloads section. Please remember that these are for teaching-learning purposes only.
    Comments 39 Comments
    1. physiostudent's Avatar
      physiostudent -
      Greatly informative and takes you through the basics brilliantly.Cheersphysiostudent
    1. Christine's Avatar
      Christine -
      Brilliant. Studying pulmonary auscultation for a uni assignment. Great work
    1. Natasha's Avatar
      Natasha -
      thanks for the informative article.It tackles the nuances of resp auscultation in a very lucid manner.Good for beginners
    1. Manju CA, RN's Avatar
      Manju CA, RN -
      Excellent.It is a very good article for nurses to know about various Lung sounds.
    1. Mary's Avatar
      Mary -
      Wow, this is my dream come true... I want more auscultation explanations!
    1. Che's Avatar
      Che -
      Recommended site for identifying lung sounds. Thumbs up!
    1. Popcorn's Avatar
      Popcorn -
      Super Thank you!
    1. majid zakir's Avatar
      majid zakir -
      awesome...big help.
    1. pgv's Avatar
      pgv -
      thanx you very much,it's a great work.
    1. Paras bhardwaj's Avatar
      Paras bhardwaj -
      Thank you,Breath sounds explained here are really helpful.
    1. Luci's Avatar
      Luci -
      I find it incredibly difficult to distinguish between all of the above, so this was really helpful, thank you
    1. Mark's Avatar
      Mark -
      Daria loves this site and all articles
    1. Lew's Avatar
      Lew -
      Thanks for all the audio clips in this article. Best I have heard on the internet.
    1. ANIRUDDHA LAHA's Avatar
      ANIRUDDHA LAHA -
      THANKS for giving me such nice audio clips.
    1. Subhashini's Avatar
      Subhashini -
      Thanks for this wealth of information on breath sounds!
    1. Unregistered's Avatar
      Unregistered -
      Thank you - nurse working in minor illness - different doctors can use different terms for the same thing - was getting confusing! Great to have some clarity! Very helpful.
    1. klvn26's Avatar
      klvn26 -
      Thank you Sir for the explanations and sound clips..i still find it tough to differentiate them though...hopefully will be able to do so with experience, will work on it ^^
    1. Unregistered's Avatar
      Unregistered -
      Really great..
    1. Aneurysm's Avatar
      Aneurysm -
      What I love the most in your explanation is the attention to detail. You know what mistakes we commonly do as undergraduates and have focused on that... not many people write with this clarity. Please do write on more such topics. Thanks!
    1. erixo75's Avatar
      erixo75 -
      I'm a IMG preparing for USMLE step 2 CK, this is really useful for every year media questions are increasingly being incorporated. Thanks a million !
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