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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
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.
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.
Bronchial Breath Sounds
Bronchial breath sounds are usually loud, high-pitched and sound close to the stethoscope.
Character of the sound is HOLLOW. There is a gap between the inspiratory and expiratory phases of respiration, and 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).
- Consolidation
- Cavity
- Upper level of pleural effusion
- Upper lobe fibrosis
- Upper lobe collapse
- bronchopleural fistula
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 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.
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