Rattling in the chest

Wheezing in the chest as an independent ailment is extremely rare in clinical practice. More often, this condition is a symptom of a serious illness.

To diagnose possible ailments, it is first necessary to find out whether wheezing is sporadic, appearing only for a short period of time, or is a systemic manifestation. The second option occurs an order of magnitude more often, which signals the start of a pathological process in the body, which, if the problem is ignored, can lead to serious disorders.

To determine how strong sound manifestations disturb the victim, during the initial appointment, the doctor listens to the patient with a phonendoscope. With the advanced form of the disease, a suspicious noise can be heard even with the naked ear.

Clinical characteristics of wheezing

Wheezing refers to any form of non-physiological noise that occurs in addition to direct inhalation or exhalation. This also includes wheezing, which develops with pleurisy due to friction of the pleura against the ribs. The presence of specific noises is due to the fact that the air stream passing through the upper respiratory tract into the lungs for gas exchange encounters some obstacles that may arise due to narrowing of the bronchial lumen, or ingestion of a foreign body or lumps of mucus and food.

When inhaling, wheezing may differ in tone, duration, prevalence, during exhalation or inhalation, on the basis of which the doctor can diagnose a number of pathologies.

Noises during breathing and other conditions of the patient, as a rule, indicate the disease. We are talking about the accompanying dry cough, pain, elevated body temperature. All this against the background of wheezing sounds indicates the progression of the disease and the need for urgent qualified assistance in order to prevent the development of complications. It is especially important to respond in time if a deterioration in well-being is noted in a child. Weak children’s immunity is not able to protect the baby’s body, therefore, if the first alarming signs are found in the baby, you should immediately seek the advice of a doctor.

The classification includes the division of breath sounds into:

• dry;
• wet;
• whistling;
• crunchy (crepitus).

Dry wheezing develops when the passage of air through the respiratory tract slows down. If, along the way, the patient is found to have fluid in the organs of the respiratory system, then, as a rule, moist rales are heard.

The tone of the noise directly depends on the degree of airway obstruction, as well as on the viscosity of the circulating secret. The greater the air obstruction in the bronchi, the higher the wheezing will be in tone. Moreover, they are equally intense both during inhalation and exhalation. In the first case, we are talking about the inspiratory category of sound effects, and in the second – about the expiratory one. Also, the doctor should take into account the factor of individual characteristics of the surrounding affected tissues in order to finally determine the sonority of the tones heard.

Before determining the tactics of subsequent diagnosis and treatment, it is necessary to clarify the localization of the noise. With a dense tissue structure, which is typical for pneumonia, or the space near the bronchi mesh, the sounds become especially sonorous. If the patient’s lung function is not affected, then the lung tissue retains an airy, as it were, porous structure, which is why the echoes of inhalation and exhalation are heard somewhat muffled.

A separate classification exists for the division of moist rales, representing a division into three groups:

• fine bubbles;
• medium bubble;
• large-bubbly.

Diagnosis depends on the characteristic of moist rales in the patient. When confirming the small bubble type, all medications should be aimed at removing the fluid that accumulates in the smallest bronchi. Accordingly, with the defeat of the middle bronchi, medium bubbling rales are heard, and with the defeat of the large bronchi – coarse bubbling. All this indicates the clinical course and, accordingly, the tactics of treating bronchitis.

According to localization and etiology is division of:

• pulmonary;
• extrapulmonary murmurs.

Pulmonary murmurs are diagnosed only in the presence of a pathological process in the bronchopulmonary system. With heart failure at different stages of the development of the disease, there may also be complaints about noise.

Wheezing as a symptom of illness

Despite the stereotype that a specific whistle is a companion of exclusively various colds, it often accompanies other pathological processes.

Indeed, most often these symptoms are manifested in viral infections, influenza, parainfluenza, chronic obstructive pathologies of the lungs and bronchi, pneumonia, bronchial asthma. But there are a number of ailments that are not associated with “seasonal diseases”, but are still accompanied by just such annoying symptoms.

Separately, cases of infection with pulmonary tuberculosis are considered, in which, due to incorrect treatment, the bronchi are often also involved.

Also, hoarseness without coughing may be associated with the development of oncological neoplasms. Therefore, it is important to timely contact a doctor, who, after an initial examination, can refer you for further examination to clarify the diagnosis.

Based on the above pathologies, it becomes clear why this symptom cannot be classified as specific. Without a preliminary differential diagnosis, it is difficult to determine even the primary diagnosis. That is why it is so important not to try to look for how to get rid of non-physiological noises on your own without first consulting a doctor.

Various approaches are used to make a definitive diagnosis, including:

• percussion;
• auscultation;
• fluorography;
• radiography;
• laboratory tests.

During the initial examination of an adult patient, the doctor performs auscultation using a phonendoscope, stethophonendoscope or stethoscope in several positions. Also, the effectiveness increases when listening to the chest in turn from the left and right sides. The patient is asked to use different breathing patterns to determine the location of the noise effect.

When diagnosing, the individual results of testing the patient for the following wheezing parameters are necessarily recorded:

• caliber;
• key;
• timbre;
• sonority;
• prevalence.

Characteristics such as the uniformity of wheezing and their periodicity are also determined. In some diseases, non-physiological noises can change with a change in body position. If this occurs when coughing or deep inhalation-exhalation, then this information must be entered into the medical record.

Distinctive features of wet rales

Regardless of the localization of painful sensations, or only long-term wheezing, it is necessary to consult a therapist, and only then begin treatment.

If during the examination of the patient it turns out that he has wet rales, then various fluids have begun to accumulate in his airways. This is an inflammatory exudate, which can be mixed with mucus, sputum, waste products of pathogens, and sometimes blood.

Most of the clinical cases with wet rales are associated with inflammatory conditions. For their differential diagnosis, additional laboratory and instrumental studies may be required. Based on all the data collected, the patient is given a definitive diagnosis, which, with moist breath sounds, may be associated with one of the following common ailments:

• primary ciliary dyskinesia;
• Williams-Campbell syndrome;
• bronchial asthma immediately after an attack;
• recurrent, chronic, obstructive bronchitis;
• chronic obstructive pulmonary disease;
• pulmonary edema;
• tuberculosis;
• pneumonia;
• bronchiolitis.

Pulmonary embolism is less common; in a baby who suddenly becomes hard to breathe, even cystic fibrosis can be detected.

With insufficiently effective treatment, pneumonia can cause a sharp deterioration in well-being, up to fainting with the need for emergency hospitalization of the victim. A lung abscess, which develops extremely rapidly, can even lead to death.

To prevent a sad outcome, you should not be interested in whether inhalation will help in situations where wheezing is clearly audible even without special medical instruments. Only emergency hospitalization with the provision of professionally prescribed assistance will help here.

Features and characteristics of dry rales

Often, dry non-physiological noises appear due to turbulent eddies of the air flow as it passes through the inflamed airways. The doctor can differentiate such symptoms on the basis of their unusual sound accompaniment with different lengths and timbres.

The presented state of a permanent nature is explained by the narrowing of the bronchial lumen, which is a consequence of the swelling of the mucosa. Moreover, the edema itself can be both acute and periodic.

Often, the natural diameter of the lumen of the bronchus narrows due to the ingress of a foreign body, a lump of mucus, and sputum. In the most dangerous scenario, the obstacle is the compression of the natural path by tumors of various sizes, so dry noises for the most part belong to the group of obstructive pathologies.

In order to finally understand how serious the clinical picture is in an individual patient, you must first determine the degree of damage to the bronchial lumen.

The assessment of sounds in three “shades” will help in this:

• buzzing;
• buzzing;
• whistling.

However, this “tonal separation” of wheezes is not able to be distinguished by the patient, trying to read the diagnosis in the medical card after leaving the doctor’s office. So, when whistling, small bronchi, bronchioles fall under the blow, a buzzing sound indicates damage to large bronchi.

Problems in diagnosing a dry variety of sound are added by the fact that some patients who have not consulted a doctor and self-medicated cannot distinguish them from other noises. Only auscultation, carried out in accordance with all the rules with a change in respiratory modes and taking into account the phases of contraction of the heart muscle, will help to finally determine the diagnosis.

Some pathologies that are characteristic of wet rales may also be characteristic when listening to dry rales. We are talking about chronic bronchitis, bronchial asthma, pneumonia, chronic bronchiolitis.

But this category may also have “own” ailments:

• pneumosclerosis;
• emphysema of the lungs;
• pharyngitis;
• laryngitis;
• lungs’ cancer;
• foreign body in the lumen of the bronchus.

In rare cases, hoarseness is formed as a compensatory reaction to dry air. Occasionally, the provocateur of the onset of such a state is old age, when people breathe shallowly. Here, the situation will be corrected by a few vigorous respiratory movements, or a forced cough. This kind of deviation is of a compensatory-adaptive nature and does not pose a particular threat.

Which doctor to contact

To determine the cause of anxiety, you should first make an appointment with a therapist, who, if necessary, will issue a referral to a specialist. When the problem lies in disorders of the respiratory system, the patient is referred to a pulmonologist.

An order to visit a highly specialized specialist is received by patients who, in addition to wheezing, additionally have periodic attacks of suffocation, pressure inside the chest, which blocks the natural inhalation-exhalation mechanism.

If, when listening with a phonendoscope, a whistle is clearly traced, then this indicates suspicions of bronchial asthma, which only a pulmonologist-allergist can help cure.

To make a final diagnosis and develop a treatment regimen, the patient is sent for a laboratory examination, including a general urine and blood test. This will eliminate the most common diseases: influenza and other SARS. In the latter case, a specific test may be added to identify the causative agent of the disease. Only in this way the therapy will be as effective as possible, restoring the patient’s health in the shortest possible time without significant complications.

If a pulmonary form of tuberculosis is suspected, a general sputum analysis is performed, which will help determine whether wheezing is a harbinger of an open (contagious) form, or a closed one (when a person is safe for society).

Separately, the need to determine the immune status is considered. Specific types of diagnostics also include allergic tests to detect the degree of sensitivity to various allergens, as well as peak flowmetry, spirometry.

Much more often, patients are sent to take a biochemical blood test and take x-rays of the lungs. If blackouts, stains are found on the x-ray, additional examination is possible using magnetic resonance imaging, computed tomography.

According to indications, bronchoscopy can be performed, if there is a suspicion of pus in the bronchi, or with bronchial tuberculosis. As a rule, the procedure is performed under local anesthesia, taking into account the possible allergic reaction to painkillers.

If heart failure is suspected, which may result in wheezing of varying severity, it is necessary to undergo electrocardiography. The result of the study of the gas composition of the blood will complement the general idea.

Only timely diagnosis and following the instructions of the attending physician will avoid aggravating the condition of the victim. There is no need to wait until, along with a suspicious “rustling” in the chest, legs begin to break, upper limbs go numb, get sick or even dizzy.

If you find the first warning signs in yourself, you should immediately seek help from a specialist. And in the event of sudden and intense wheezing, it is recommended to immediately call an ambulance brigade.

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