Breath Sounds part 2 - Wheezes

#KYJ -Knowing your Jargon

Breath sounds part 2. 

Wheezes.

In part one http://knowingyourjargon.blogspot.com.au/2016/02/breath-sounds-part-1.html?m=1

We looked at the concept of pitch in breath sounds. In that episode we discussed the two major groups of abnormal (adventitious) lung sounds. We focused on crackles.

In this episode we look at the other group, the Wheezes.

Wheezes are a sound produced by air being squeezed through narrow swollen oedematous bronchi/bronchioles.  They can occur during inspiration (stridors) or expiration (wheezes).

Like crackles, wheezes are pitched differently, depending on the area of lung affected.  High pitched wheezes are heard in the periphery of the lung, whereas low pitched wheeze come from larger airways.  Like crackles, wheezes are termed differently depending on the area they originate.

High pitched wheeze is called a sibilant wheeze.   Sibilant is a whistle like sound of high frequency (high pitch). It is characteristically heard in asthmatic flare-ups.

Low pitched wheezes originate from bronchi and trachea, and sound like snoring.  In fact this is exactly what they are called, "snorous wheezes".  In older texts, you may hear these called Rhonchi (pronounced 'Ronk-Eye').

Typically these wheezes are heard in multiple areas of the lung field.  For this reason it is not uncommon to hear multiple different pitches.  Wheezes of this nature that demonstrate both snorous and sibilant qualities are frequently documented as widespread polyphonic (many voices) wheezes.  Asthma is a classic presentation.

Listen carefully to a wheeze; especially if the patient has cardiac or hepatic history, and after any rapid IV fluid infusion.  If crackles can be heard along side a sibilant wheeze, then a diagnosis of acute pulmonary oedema (APO) needs to be excluded.

So similar is an acute asthma wheeze and an acute pulmonary oedema wheeze, that at one time APO was called "Cardiac Asthma".

So that is it for this short episode. Next edition we look at where a stethoscope is placed.

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