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Auscultation of the lung remains an essential part of physical examination even though its limitations, particularly with regard to communicating subjective findings, are well recognised. The European Respiratory Society (ERS) Task Force on Respiratory Sounds was established to build a reference collection of audiovisual recordings of lung sounds that should aid in the standardisation of nomenclature. Five centres contributed recordings from paediatric and adult subjects. Based on pre-defined quality criteria, 20 of these recordings were selected to form the initial reference collection. All recordings were assessed by six observers and their agreement on classification, using currently recommended nomenclature, was noted for each case. Acoustical analysis was added as supplementary information. The audiovisual recordings and related data can be accessed online in the ERS e-learning resources. The Task Force also investigated the current nomenclature to describe lung sounds in 29 languages in 33 European countries. Recommendations for terminology in this report take into account the results from this survey. @ERSpublications Creation of a reference collection of respiratory sounds to unify nomenclature and serve as a resource in education

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BackgroundThe European Respiratory Society (ERS) lung sounds repository contains 20 audiovisual recordings of children and adults. The present study aimed at determining the interobserver variation in the classification of sounds into detailed and broader categories of crackles and wheezes.MethodsRecordings from 10 children and 10 adults were classified into 10 predefined sounds by 12 observers, 6 paediatricians and 6 doctors for adult patients. Multirater kappa (Fleiss' κ) was calculated for each of the 10 adventitious sounds and for combined categories of sounds.ResultsThe majority of observers agreed on the presence of at least one adventitious sound in 17 cases. Poor to fair agreement (κ<0.40) was usually found for the detailed descriptions of the adventitious sounds, whereas moderate to good agreement was reached for the combined categories of crackles (κ=0.62) and wheezes (κ=0.59). The paediatricians did not reach better agreement on the child cases than the family physicians and specialists in adult medicine.ConclusionsDescriptions of auscultation findings in broader terms were more reliably shared between observers compared to more detailed descriptions.

To investigate the effect of age and body size on normal lung sounds, we studied 10 newborn infants within 3 d after birth, nine children between 6 to 8 yr, and 10 adults between 25 and 37 yr of age. Lung sounds were recorded with a contact transducer over the posterior right lower lobe, and air flow was measured at the mouth. Computer analysis provided average power spectra of lung sounds at flows of 15 ml/s/kg. In children and adults measurements were also made at flows of 30 ml/s/kg. Lung sounds were referenced to background noise, measured at zero air flow. The spectra in infants contained less power below 300 Hz compared with children and adults, resulting in significantly higher quartile and spectral edge frequencies. Resonances of the thoracic cavity may explain some of the differences among the study groups. Sound attenuation above 300 Hz was similar at all ages. At increased air flows, lung sounds in children and adults were above background noise at frequencies as high as 2,000 Hz. High-frequency expiratory lung sounds of low intensity were present in all children and in eight of 10 adults at increased flows. Normal lung sounds of low intensity are present above traditionally accepted frequency limits and warrant further investigation.

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Context.-The effectiveness of glucocorticoids for patients with croup is well established but it remains uncertain which glucocorticoid regimen is most effective.Objective.-To determine the effectiveness of 3 glucocorticoid regimens in patients with croup.Design.-Randomized controlled trial with parallel design. Setting.-Emergency departments of 2 Canadian pediatric tertiary care hospitals.Participants.-Children with a clinical syndrome consistent with croup, aged 3 months to 5 years, with a croup score of 2 or greater following at least 15 minutes of mist therapy.Interventions.-Oral dexamethasone, 0.6 mg/kg, and nebulized placebo; oral placebo and nebulized budesonide, 2 mg; or oral dexamethasone, 0.6 mg/kg, and nebulized budesonide, 2 mg.Main Outcome Measures.-Westley croup score (primary outcome), hospital admission rates, time spent in the emergency department, return visits to the emergency department, or ongoing symptoms at 1 week.Results.-The mean change in the croup score from baseline to the final study assessment was −2.3 (95% confidence interval [CI], −2.6 to −2.0) in the budesonide group (n = 65), −2.4 (95% CI, −2.6 to −2.2) in the dexamethasone group (n = 69), and −2.4 (95% CI, −2.7 to −2.1) in the budesonide and dexamethasone group (n = 64, P = .70).Conclusions.-Based on the similar outcomes in the 3 groups, oral dexamethasone is the preferred intervention because of its ease of administration, lower cost, and more widespread availability.

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