Respiratory noises are sounds that occur when breathing. A doctor or a paramedic can listen to them by placing the ear directly on the patient’s chest wall or using a stethoscope or phonendoscope (see Auscultation). When listening to pulmonary sounds, it is necessary to pay attention to their relation to the respiratory phases (inhalation, exhalation), localization and distribution, nature and strength.
Respiratory noises are divided into two main groups: vesicular and bronchial respiration. The occurrence of vesicular respiration is due to the tension of the walls of the pulmonary alveoli as a result of the entry of air into them. Therefore, it is heard throughout the entire inhalation and only at the very beginning of the exhalation (due to the collapse of the alveoli). The intensity of vesicular respiration varies depending on the age, fatness and pathological processes in the lungs. In children, vesicular breathing is usually enhanced, exhalation is clearly audible (pueril breathing).
This character of breathing persists to 12-14 years of age and is explained, apparently, by the fineness of the chest wall, and also by the relative narrowness of the bronchi.Go
The weakening of vesicular respiration in pathology may be due to obstructed passage of air into the alveoli during narrowing of the upper respiratory tract or large bronchi; insufficient expansion of the lungs during inhalation as a result of limiting the mobility of the chest with reflex effects (with pain in the chest) or pathological changes of the musculoskeletal system (ossification of costal cartilages, paralysis of the respiratory muscles), with a very high standing of the diaphragm. The weakening of vesicular respiration is observed in emphysema of the lungs, in the initial phase of lobar pneumonia, as well as accumulation of fluid in the pleural cavities, pushing the lung from the chest by the tumor, fusion of the pleura , etc. In some cases, weakened vesicular respiration is heard throughout the lungs ( emphysema lungs , narrowing of the upper respiratory tract), in others - on one side or even on a limited part of the chest (focal pneumonia, effusion pleurisy , atelectasis of the lung). Local weakening of vesicular respiration is best detected by comparing the power of respiration in symmetrical areas of the chest to the right and left.
Strengthening of vesicular respiration is due to the large force of the alveoli unfolding during inhalation (for example, during physical work, sometimes with fever, as a compensatory phenomenon in the vicinity of a poorly ventilated lung area). Rigid vesicular breathing - coarser, strengthened, somewhat rough with prolonged exhalation; observed with narrowing of the lumen of the bronchi, bronchitis, bronchopneumonia.Go
Intermittent or saccadic breathing, characterized by intermittent, jerky inhalation as a result of air entering the alveoli in several stages, is observed with an uneven contraction of the respiratory muscles.
Bronchial breathing is characterized by a peculiar sound phenomenon resembling the sound of "x", and the exhalation is louder and rougher than inhaling. Bronchial respiration is associated with the passage of air through the glottis and the turbulence of air that is formed. Since when exhaling, the glottis is more narrowed than during inhalation, the sound produced during this phase is stronger, rougher and longer. Bronchial respiration, bugged outside the area of the trachea and large bronchi, indicates the presence of pathological changes: compressed lung tissue or cavity that connects to the bronchus. In the first case, physiological bronchial respiration is better carried out with a compacted tissue, in the second, physiological bronchial respiration is enhanced due to the resonance of the cavities. Most often, bronchial respiration occurs as a result of inflammatory processes in the lungs, accompanied by compaction of the lobe or its part (lobar pneumonia), compression of the lung ( exudate , tumor, etc.). A type of bronchial breathing is an amphoric respiration, resembling a sound that is produced if one blows heavily over the throat of an empty glass vessel. Amphora breathing is heard above the cavity in the lung of considerable size and with a smooth surface inside.
Mixed, broncho-vesicular, respiration is characterized by the presence of vesicular breathing on inspiration and bronchial exhalation. Normally he listens to the tip of the right lung, in pathology - with pulmonary tuberculosis, focal pneumonia.