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What Sounds Might You Hear During An Asthma Exacerbation

Assess Capnography Work Of Breathing Lung Sounds And Pulse

What is an acute exacerbation?

EMS is often called when asthma attacks are worse than ones a patient normally experiences, when a patient is not compliant with their treatment plan, or they do not get better after treatment at home. Ask patients if their current asthma attack is worse than any they have had in the past, if they have ever been intubated for an asthma attack, and if they have used any inhalers or breathing treatments before calling. This helps predict which EMS interventions will be effective and whether assisted ventilation will be needed.

Patients having mild asthma attacks are able to speak in full sentences. Wheezing may be heard at the end of exhalation. In moderate to severe attacks, patients may be seated upright in a tripod position, get winded with speaking, use accessory muscles to breathe, and have supraclavicular and subcostal retractions. Wheezing may be heard throughout exhalation. Also expect the patient to have altered mental status, such as awake and anxious during a moderate attack.

Patients having a severe attack may have difficulty holding their head up from respiratory muscle fatigue and hypoxia, and only speak in short phrases. Wheezing may be heard on inhalation and exhalation, or breath sounds may be diminished or absent. Decreased level of consciousness is another sign of the seriousness of a severe asthma attack.

Asthma Signs & Symptoms

People with asthma experience symptoms due to inflammation in the airways. They might only occur when you encounter an asthma trigger. Common symptoms that can lead to a diagnosis of asthma include:

  • Persistent or recurring coughing: which often occurs at night or early in the morning, although it can happen at any time. Coughing is a major feature of asthma, especially in children and can sometimes be the only sign of asthma.
  • Wheezing: is difficulty breathing accompanied by a whistling sound coming from your airways
  • Shortness of breath: gives you the feeling that you cant get enough air into your lungs, and may even find it difficult to eat, sleep or speak
  • Chest tightness: an unpleasant sensation of heaviness or pressure in the chest that can make it hard to breathe
  • Increased mucus production: is characterized by high levels of thick fluid or phlegm accumulating in your airways
  • Difficulty breathing while exercising: having trouble breathing while performing physical activities can be a sign of asthma
  • Losing Sleep: Being unable to sleep through the night because of breathing troubles

Contact Doctor During Office Hours

  • Don’t have written asthma action plan from your doctor
  • Use an inhaler, but don’t have a spacer
  • Miss more than 1 day of school per month for asthma
  • Asthma limits exercise or sports
  • Asthma attacks wake child up from sleep
  • Use more than 1 inhaler per month
  • No asthma check-up in more than 1 year
  • You have other questions or concerns

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Do You Hear Rhonchi On Inspiration Or Expiration

Rhonchi are long continuous adventitious sounds, generated by obstruction to airways. When detected, note whether it is generalized or localized, during inspiration or expiration, and the pitch. Evaluate the rhonchus in upright, supine and decubitus positions. Loud audible inspiratory rhonchi is called a stridor .

Airway And Lung Injury

Asthma Auscultation

Symptoms of acute lung injury may have developed by the time of patient presentation but are most often delayed up to 24 hours after the initial insult.10,11 The peak in mucosal changes with sloughing and mucopurulent membrane production may be delayed up to 72 hours. Clinical findings on lung auscultation often precede abnormalities seen on chest radiograph, such as atelectasis, edema, or interstitial infiltrates, by 12 to 24 hours.11

Children who have suffered burns by flame or have a history of smoke inhalation or smoke exposure in a closed space are at increased risk for airway compromise. Even without the classic signs of facial burns, singed nasal or facial hairs, hoarseness, stridor, and carbonaceous sputum, significant airway inflammation and edema can ensue. Mucosal injury threatens airway patency as a consequence of increased capillary permeability, tissue swelling, and plugging of distal airways with sloughed, injured tissue. Progressive upper airway edema and bronchospasm are often responsible for deterioration within the first 12 hours.9 Vigilant airway surveillance is critical when monitoring for early mucosal edema. Serial observation by fiberoptic laryngoscopy and bronchoscopy can be used in an intensive care setting to assess the degree and extent of injury.

Mark Ballow, Heather K. Lehman, in, 2014

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When To Call The Doctor

Because wheezing is never normal, contact your doctor or go to the emergency room if:

  • Wheezing is new
  • Wheezing is not new, but getting worse
  • You have any other symptoms, such as a change in skin color or you do not seem to be thinking clearly
  • Wheezing occurs after taking a new medication, you are bitten by an insect, or seems to have been caused by something you’ve eaten

If you are already being treated for asthma and you are still wheezing significantly, your asthma action plan may not be working as well as it should or you aren’t following it correctly. When your asthma is well controlled, you should not experience wheezing. In many cases, tweaking a prescription may be all it takes to keep asthma symptoms such as wheezing at bay.

Normal Lung Or Vesicular Breath Sounds

Vesicular breath sound is a misnomer as vesicles means alveoli, and this gives the impression that the breath sound is originating at the alveolar level. However, breath sounds cannot be generated at the alveolar level since airflow is laminar within the alveoli. The expiratory sound is audible only in the early phase. The short expiratory phase is due to the passive nature of expiration resulting in generation of less turbulent airflow. The origin of both phases of respiration is also indifferent sites. The inspiratory component originates in the lobar and segmental airways, whereas the expiratory component arises from more central airways. Therefore, turbulence generated during expiration moves away from the chest wall and become fainter. Lung sounds normally peak at frequencies below 100 Hz, with a sharp drop of sound energy occurring between 100 and 200 Hz, but it can still be detected at or above 800 Hz with sensitive microphones. There are regional variations in the intensity of breath sound. At the apex, intensity decreases with the progression of inspiration performed from residual volume whereas, at the base, initially the sound is less intense, and with the progression of inspiration, the intensity gradually increases.

Showing vesicular breath sound

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What Is A Silent Chest In Asthma

As your lungs continue to tighten during the asthma attack, you may be unable to use the peak flow meter at all. Gradually, your lungs may tighten so much during the asthma attack that there is not enough air movement to produce wheezing. This is sometimes called the silent chest, and it is a dangerous sign

Mechanism Of Breath Sounds Production

Asthma in Survival Settings: Part 2 Lung Sounds and Treatments

The prerequisite for normal breath sound production is the air flow along the trachea-bronchial tree however, not all types of airflow produce breath sound. Only turbulent and vorticose airflow are responsible for breath sound production. Laminar flow occurs in low flow situations and is silent . The streams of airflow are parallel to the walls. It is parabolic in shape as air in the central layers moves faster than air in the peripheral layers, with little or no transverse flow. Therefore, there is little mixing or collision between layers of gas. Laminar flow pattern follows the Poiseuille equation, as shown below .

Showing Poiseuille equation

Showing turbulent flow

The development of vortices is another mechanism for breath-sound generation . Vortices or whirlpools are formed when a stream of gas that emerges from a circular orifice to a wider channel. It occurs between the fifth and the 13th generations of the bronchial tree. Respiratory sounds heard in the chest wall undergo attenuation by the lungs and the chest wall. The lung parenchyma and chest wall act as a low-pass filter, not allowing high frequency sounds to pass through. Therefore, the sound heard over the chest wall consists mainly of low frequencies. The low pass filtering function is responsible for a sharp drop in sound energy between 100 and 200 Hz. Based on the frequency, respiratory sounds are classified into the following groups: Low , middle , and high frequency .

Showing transitional flow

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How Do I Know If A Flare

Here’s a good way to see how bad a flare-up is: measure your peak expiratory flow using a peak flow meter. Your doctor can show you how to use a peak flow meter to keep track of your asthma. A peak flow meter costs less than $30, and you only have to buy it one time. First, you find out your personal best peak flow. This is the highest reading you can get on the meter over a two-week period when your asthma is under good control.

Here are some general guidelines you can use to find out how serious an asthma flare-up is:

During mild flare-ups, you may notice shortness of breath when you walk or exercise, but when you sit still, you feel okay. You can usually breathe well enough to talk in complete sentences. You may hear some wheezing, mostly at the end of exhaling . Your peak flow readings will be 80 to 100 percent of your personal best.

  • During moderate flare-ups, you may feel short of breath when you talk or lie down, but if you sit quietly, you feel better. You may talk in a few words rather than using whole sentences because you’re short of breath. You may feel anxious or tense. You may be using your neck muscles to help you take deeper breaths. You may hear loud wheezing, especially when you breathe out. Your peak flow readings will be about 50 percent to less than 80 percent of your personal best.

  • What Causes Wheezing

    Wheezing is a sign of bronchoconstriction, a narrowing of the airways of the lungs that impedes the flow of air to and from the lungs, creating a whistling noise during breathing. Again, it’s most common when you breathe out, but can also occur when you breathe in, which may indicate especially advanced asthma.

    Bronchoconstriction that occurs in asthma is the result of an inflammatory response to a trigger such as pollen, smoke, or an infection. Triggers differ among people with asthma but in all cases they cause inflammation and tightening of the airways.

    In addition to wheezing, which is often the first sign of asthma or an impending asthma attack, there are other classic symptoms of asthma:

    • Chronic cough
    • Chest tightness

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    Can Asthma Be Cured

    There is currently no known cure for asthma, but with proper diagnosis and asthma management it is fully possible for people with asthma to live healthy, active and symptom-free lives.

    There is still much research that needs to be done to fully understand how to prevent, treat and cure asthma. Asthma Canadas National Research Program is committed to supporting leading asthma researchers and graduate student researchers working to expand our knowledge and one day, unlock a cure.

    What Is The Role Of Wheezing In The Assessment Of Asthma

    Tracheal breath sounds are heard over the trachea. These ...

    Wheezing, a musical, high-pitched, whistling sound produced by airflow turbulence, is one of the most common symptoms. In the mildest form, wheezing is only end expiratory. As severity increases, the wheeze lasts throughout expiration. In a more severe asthmatic episode, wheezing is also present during inspiration. During a most severe episode, wheezing may be absent because of the severe limitation of airflow associated with airway narrowing and respiratory muscle fatigue.

    Asthma can occur without wheezing when obstruction involves predominantly the small airways. Thus, wheezing is not necessary for the diagnosis of asthma. Furthermore, wheezing can be associated with other causes of airway obstruction, such as cystic fibrosis and heart failure. Patients with vocal cord dysfunction, now referred to as inducible laryngeal obstruction , have a predominantly inspiratory monophonic wheeze , which is heard best over the laryngeal area in the neck. Patients with excessive dynamic airway collapse , bronchomalacia, or tracheomalacia also have an expiratory monophonic wheeze heard over the large airways. In exercise-induced bronchoconstriction, wheezing may be present after exercise, and in nocturnal asthma, wheezing is present during the night.

    References
  • National Asthma Education and Prevention Program. Expert Panel Report 3 : Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Allergy Clin Immunol. 2007 Nov. 120 :S94-138. .

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    Dynamic And Static Image Features

    Peak inspiratory images for each of the study groups are presented in Data Supplements S1âS4 . The static and dynamic images had differences as described below. In all subjects, the dynamic images âbuild and fadeâ twice for every respiratory cycle, once for inspiration and again for exhalation. In the healthy control subjects, the maximal vibration intensity in inspiration is visually greater than that in exhalation. Sound patterns develop synchronously in both lungs. Right and left lungs viewed together have peripheral smooth, rounded, and uninterrupted contours. Planar distribution, area, size, and intensity of the right and left lung images are similar. The planar sound images for the CHF patients were visually similar to those of the healthy controls. In the subjects with COPD, the dynamic images showed asynchrony within each lung, and different areas of each lung demonstrated peaks in sound energy at different times. Because of this asynchrony, the contours of the lung periphery on the planar images are not smooth, but have a âbumpy-lumpyâ appearance . In the subjects with asthma, the dynamic images showed asynchrony between lungs, and maximal vibration energy occurred not during inspiration, as with normal subjects, but during expiration.

    What Is Acute Severe Asthma

    Acute severe asthma is more commonly known as an asthma attack. These are exacerbations of asthma that come on suddenly. Signs and symptoms might include a wheeze, fast breathing, a fast heart rate, altered consciousness, inability to speak or speak full sentences, a silent chest, prolonged expiration , sweating, or numbness.

    Signs and symptoms that indicate the asthma attack is moderate include a pulse rate over 110 beats per minute , fast breathing, inability to speak in full sentences, and a peak expiratory flow reading which is 50 % less than normal. There can also be a loud wheeze. In even more severe asthma attacks, the heart rate can increase to over 120 beats per minute and the breathing rate can increase to over 30 breaths per minute. They might be breathless, agitated, or unable to speak full words. If a person suffering from an asthma attack is breathing extremely slowly, appears confused, exhausted, or unconscious, cannot speak at all, and has blue fingernails or blue lips, it is a sign that the asthma attack is becoming life threatening and needs urgent treatment. If you suspect someone is having an asthma attack, call for an ambulance.

    Asthma attacks are rarely fatal if treated adequately.

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    Auscultation Of Breath Sounds In Ipf

    Auscultation of the lungs is an important component of a physical examination because respiratory sounds provide vital information regarding the physiology and pathology of lungs and airways obstruction.1 The ability to distinguish normal breath sounds from various abnormal adventitious sounds is essential to make an accurate medical diagnosis.1Breath sounds are generated by airflow in the respiratory tract and include normal and adventitious sounds.1 Adventitious sounds are additional respiratory sounds superimposed on normal breath sounds and usually indicate pulmonary disorders.1 For many years a complex, conflicting, and confusing body of terms was used to describe respiratory sounds.2 In order to establish a more objective naming system, in 1985 an ad hoc committee of the International Lung Sounds Association agreed on a nomenclature that divided adventitious sounds into 2 major categories: continuous sounds or wheezes, and discontinuous sounds or crackling noises .2 These terms are defined acoustically and do not assume a generating mechanism or location.34

    Table 1.Lung Sound Nomenclature. Adapted from Mikami R, et al. Chest. 1987 92:342-345.

    Lung Sound Category
    Rhonchus

    How To Handle A Wheeze

    Wheezing (expiratory) – Lung Sounds – MEDZCOOL

    Most people can control their sudden asthma symptoms, such as a wheeze, with a bronchodilator inhaler, says Castriotta. The soothing effects of a short-acting beta2-antagonist inhaler, such as an albuterol inhaler, can be felt in about 10 minutes. These inhalers help open your airways so you can breathe more easily and without wheezing.

    Here are some practical tips that can help you manage a wheeze or other asthma symptoms:

    In the end, learning about your asthma, and knowing what youre up against, can help you gain better control of any wheezing and help you manage your condition more effectively.

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    What Should I Do If I Think I Have Asthma

    If you think that you have asthma, the best thing you can do is see your healthcare provider as soon as possible for proper testing and diagnosis. Many people normalize their symptoms, without ever realizing that a symptom-free life could be possible. Its crucial to never ignore or downplay your asthma symptoms, you never know when something could trigger a potentially fatal asthma attack.

    The sooner that you get a proper diagnosis and treatment plan, the sooner you can take control of your asthma and live life to the fullest.

    Hows An Acute Exacerbation Of Asthma Diagnosed

    If youve had an acute exacerbation before, youll probably recognize the symptoms. Your doctor will be able to make a quick diagnosis.

    If its your first acute exacerbation, your doctor will need to know your medical history, particularly your history of asthma. To make a proper diagnosis, your doctor will likely perform a physical exam and a test of your lung function.

    There are several tests that may be used to see how well your lungs are working:

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