Abnormal Breath Sounds

Noisy Breathing

Normal breathing is quiet. When breathing is noisy, it’s considered abnormal breath sounds and often means something about the airway is making it more difficult for air to get through.  Most of the time, the “something” is congestion that developed due to an infection, but it can also be swelling, fluid, tissue or something swallowed (aspirated). The noise is coming from the air pushing around or through the obstruction.  The different types of obstacles make different sounds.

Mucous

If mucous is causing the problem, the solution is to try to get it out of there. Our body’s natural way of doing that is by coughing. If coughing is not bringing up anything is called a non-productive cough.  If it’s bringing up phlegm or mucous, it’s called a productive cough.
Mucous is usually clear and thin or some form of white. The thicker and darker it appears, the more likely it is that something is going on inside. However, that depends on the individual’s history.  Some chronic respiratory patients keep an underlying mucous thing going all the time, and they have yellow phlegm rolling out all year. It’s their normal—nothing to cause excitement.

Infection

However, if their normal suddenly turned green or black or bright red, then that’s another story.  Those colors are never good for anybody.  The darker the sputum in color, the worse the infection.   Additional signs of infection include fever, confusion, difficulty breathing, shortness of breath, or more noise with breathing.

Cyanosis

If the lungs fill with congestion to the point that oxygen can’t get out to the rest of the body, a crisis develops.  Often, you see cyanosis (blue-tinged coloring) in mucous membranes around the lips and fingernail beds. There is a sort of pallor that accompanies the blue tint of the skin. The person looks almost grey. They need oxygen immediately. If you have a pulse-ox that can read oxygen saturation, check to see how low the oxygen has dropped.  If you have oxygen at home, apply it immediately. If you don’t have oxygen, call 9-1-1.
Referenced: Beare, Patricia G., and Judith L. Myers. Principles and Practice of Adult Health Nursing. (1990) St. Louis: C. V. Mosby Company. 553.

Abnormal Breath Sounds

YouTube videos that provide you with examples of abnormal breath sounds. Listening to these and comparing them to the sound of normal breathing found on the Normal Respiratory Functions page will help you tell the two apart.

Abnormal Lung Sounds –  Pleural Rug, Stridor, Crackles, and Wheezes produced by RegisteredNurseRN

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Wheezes/ Rhonchi Sound Low-pitched produced by RegisteredNurseRN

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Wheezes/Rhonchi soundHigh-Pitched  produced by RegisteredNurseRN

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The Breath of Life

Have you ever taken a CPR course? If so, you probably heard about the ABCs of Life.  The ABCs reminds us of what must be treated first to keep the body alive in an emergency.

• A = Airway – check to see if anything is getting in the way of the airflow into or out of the lungs.
• B = Breathing – Is the act of breathing occurring as often, as deeply, and as effectively as it needs to happen to sustain life?
• C = Circulation of oxygen – Is oxygen exchanging places with carbon dioxide in the blood?

When someone has a medical diagnosis involving the respiratory system, most of the time, something is not right with one of the functions listed above:

• either the way they breathe is not effective,
• their airway is obstructed due to not keeping their airway clear, or
• there is something wrong with how oxygen/carbon dioxide gets exchanged.

PROTrainings offers an online CPR training program. I am an affiliate of their program and can offer you a referral discount if you are interested and taking one of their courses.  If so, the referral code is CPR-Steigleder. 

Call Your Doctor If You Have Any of the Following Symptoms

Signs of Oxygen Deprivation

• You are getting a lot of headaches.
• You feel more nervous or irritable than usual.
• Your lips, gums, area around the eyes, or fingernails are a dusky, gray, or bluish color.
• You feel drowsy or confused; children are very limp or weak.
• Your breathing is slow, shallow, difficult, or irregular. You feel like you are short of breath.
• For Children: Breathing faster than usual, flaring nostrils when breathing, making a grunting noise, the chest is pulling in with each breath, not eating well, trouble sleeping, plus any of the above.

Reference: https://medlineplus.gov/ency/patientinstructions/000048.htm

What to Tell the Doctor

Recognizing Abnormal Breath Sounds

You realize something is wrong, and you’re about to pick up the phone to call your doctor.  What information will he/she want to know from you so that he/she can make the most informed decision about the situation? How do you describe abnormal breath sounds?  He needs you to be his/her eyes and ears.   Here are the details you need to know when you call based on the symptom.

Coughing: 

• How long has the cough been present?
• Does it happen at a particular time of day or all day?
• Is it productive (producing sputum) or dry (nothing coming up)?
• What does it sound like?
• How often is it occurring?
• Does anything help relieve it?

Sputum Production:

• Is it coming up just with coughing, or must it be induced?
• What are the color, consistency, and odor?”
• How much is coming up each time?
• What is the consistency (thick, watery, frothy,

 Blood Tinged Sputum

• Rust-colored sputum -describe how much and how often.

Here are also a couple of videos on assessing the lungs that you may find helpful or interesting.
Lung Auscultation Landmarks, Sounds, Placement, Assessing Lungs  RegisteredNurseRN

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Lung Assessment Lung Auscultation Part 2 Produced by RegisteredNurseRN

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How To Describe Breath Sounds

1. Description of a Pleural Friction Rub

A pleural friction rub is caused by inflammation of the lining of the lungs rubbing together. It is heard both during breathing in and out and sounds like a low-pitch harsh/grating noise. Tell the doctor you hear it when the person breaths in and out and it sounds like scraping or grinding.
Here’s the sound of a Pleural Friction Rub produced by RegisteredNurseRN 

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2. Description of crackles (Rales & Rhonchi)

Coarse crackles (rales) are low-pitched wet, bubbling sounds heard mainly when inhaling,  but can extend into exhaling.
This is what Coarse Crackles sounds like:
Coarse Crackles and Rales Breath Sounds produced by RegisteredNurseRN

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Fine crackles are high-pitched crackling sounds heard mainly when inhaling.  In contrast, here is what Fine Crackles and Rales Breath Sounds are Like Produced by RegisteredNurseRN

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3. Description of Stridor

Stridor, a type of wheezing, is heard on inspiration and is a high-pitched whistling or gasping sound with harsh sound quality. It may be seen in children with conditions such as croup or epiglottitis, or anyone with airway obstruction. It requires medical treatment.
Stridor Vs. Wheezing produced by RegisteredNurseRN 

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