Lung sound intensity in patients with emphysema and in normal subjects at standardised airflows.

Schreur, Henk J. W.; Sterk, Peter J.; Vanderschoot, J.; Klink, H C van; Vollenhoven, E. Van; Dijkman, J. H.

doi:10.1136/thx.47.9.674

Cited by 42 publications

(19 citation statements)

References 31 publications

(2 reference statements)

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“…A correlation was also found between RMS and the HRCT findings of emphysema during expiration. The attenuated breath sounds in emphysema have been explained by airflow limitation [28,29]. Earlier studies [29] have shown that the RMS value from the power spectrum do not differ between COPD and healthy individuals in standardized air flow.…”

Section: Discussionmentioning

confidence: 99%

Lung sounds in asbestos induced pulmonary disorders

Piirilä¹,

Lehtola²,

Zitting³

et al. 2000

European Respiratory Journal

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The aim of the study was to compare the lung sounds in patients with asbestos related pulmonary disorders with findings in high-resolution computed tomography (HRCT), and with lung function variables, in order to find out associations of acoustic changes with radiological fibrosis, emphysema or with pulmonary gas transfer functions.Sixty-four patients with asbestos-related pleural disease, with or without pulmonary disease, were studied. Lung sound recording and analysis was carried out with a computerized lung sound analyser, and HRCT of the chest, as well as forced spirometry and diffusing capacity measurement were performed.The fibrosis score correlated positively with the quartile frequencies of the power spectrum of lung sounds in inspiration (f50) and expiration (f50) and crackle count in inspiration, as well as negatively with diffusing capacity. When the patients with crackling sounds and significant fibrosis were excluded (n=18), emphysema correlated negatively with expiratory quartile frequencies of the power spectrum, with f25 and f50. Furthermore, diffusing capacity correlated with inspiratory f25 and forced expiratory volume in one second with inspiratory f50 when crackles and fibrosis were excluded.Changes in lung sounds were significantly associated with radiologically verified abnormalities and gas transfer of pulmonary tissue. High sound frequencies were associated with fibrotic changes of the lung while low sound frequencies with pulmonary emphysema. Acoustic analysis gives complementary clinical information for evaluation of asbestos-related pulmonary disorders. Eur Respir J 2000; 16: 901±908.

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Section: Discussionmentioning

confidence: 99%

Lung sounds in asbestos induced pulmonary disorders

Piirilä¹,

Lehtola²,

Zitting³

et al. 2000

European Respiratory Journal

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“…However, in a study using acoustic measurements, Schreur et al proved that the breath sound intensity at a standardized airflow is not different between normal and emphysematous subjects (6). That report is based on data obtained during relatively rapid breathing (inspiratory target flow: 2 L/s, expiratory target flow: 1 L/s) and the breath sound intensity expressed at 200 Hz.…”

Section: Discussionmentioning

confidence: 99%

“…For example, Pardee et al and Bohadana et al showed that the intensity of subjectively quantified breath sound is significantly correlated with the degree of airflow obstruction (4,5), indicating that decreased breath sounds are an important sign of COPD. In contrast, Schreur et al, Sano and Malmberg et al showed that the intensity of objectively measured breath sounds is not decreased in patients with emphysema (6)(7)(8).…”

Section: Introductionmentioning

confidence: 90%

Breath Sound Intensity during Tidal Breathing in COPD Patients

et al. 2015

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Objective There is a discrepancy in the intensity of breath sounds in chronic obstructive pulmonary disease (COPD) patients between subjective studies, which have reported a diminished intensity, and objective studies using airflow-standardized measurements, which have not demonstrated a diminished intensity. We herein evaluated the breath sound intensity in COPD patients during tidal breathing in order to obtain clinically relevant results. Methods The subjects included 20 stable COPD patients and 20 normal controls. Microphones were attached to six sites on the chest wall, and breath sounds at the chest wall and airflow in the mouth were measured during resting tidal and deep tidal breathing. The octave-band power values of the breath sounds were subsequently calculated. Results 1. During resting breathing, the intensity of breath sounds during both inspiration and expiration was significantly greater in the COPD group than in the control group; the difference was prominent at higher frequency bands (>400 Hz). In addition, the power of the high frequency bands tended to be positively correlated with the CT visual emphysema scores but not the forced expiratory volume in one second, The airflow during resting breathing did not differ between the two groups. 2. During deep breathing, the intensity of inspiratory breath sounds at the dominant frequency band (200-400 Hz) was diminished over the upper and middle lung fields in the COPD group compared to that observed in the control group, while the intensity during expiration was not. The airflow during deep breathing was lower in the COPD group than in the control group. Conclusion In the present study, the breath sound intensity in the COPD patients was diminished during deep inspiration due to a reduced airflow and increased during both resting inspiration and expiration.

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“…23 Regarding abnormal and adventitious sounds, similar results of our study were reported by Kalantri et al, 25 who reported less than chance agreement ( ϭ Ϫ0.2; CI Ϫ0.57 to 0.78) on auscultating pleural rub but a 94.27% agreement between clinicians. To some extent, our results were to be expected, due to natural variance in lung sound amplitude across different lung regions, 22 which may be further altered by lung disease (eg, emphysema) 34 or ventilator settings (eg, increase in PEEP). 35 Moreover, auscultation relies on the clinician's acuity of hearing 21 ; therefore, variances in inter-rater agreement regarding the presence of breath sounds in the lower regions of the lungs may occur if its presence is subtle.…”

Section: Discussionmentioning

confidence: 99%

Inter-Rater Agreement of Auscultation, Palpable Fremitus, and Ventilator Waveform Sawtooth Patterns Between Clinicians

2016

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BACKGROUND: Clinicians often use numerous bedside assessments for secretion retention in participants who are receiving invasive mechanical ventilation. This study aimed to evaluate interrater agreement between clinicians when using standard clinical assessments of secretion retention and whether differences in clinician experience influenced inter-rater agreement. METHODS: Seventy-one mechanically ventilated participants were assessed by a research clinician and by one of 13 ICU clinicians. Each clinician conducted a standardized assessment of lung auscultation, palpation for chest-wall (rhonchal) fremitus, and ventilator inspiratory/expiratory flow-time waveforms for the sawtooth pattern. RESULTS: On the presence of breath sounds, agreement ranged from absolute to moderate in the upper zones and the lower zones, respectively. Kappa values for abnormal and adventitious lung sounds achieved moderate agreement in the upper zones, less than chance agreement to substantial agreement in the middle zones, and moderate agreement to almost perfect agreement in the lower zones. Moderate to almost perfect agreement was established for palpable fremitus in the upper zones, moderate to substantial agreement in the middle zones, and less than chance to moderate agreement in the lower zones. Inter-rater agreement on the presence of expiratory sawtooth pattern identification showed moderate agreement. The level of percentage agreement between the research and ICU clinicians for each respiratory assessment studied did not relate directly to level of clinical experience. CONCLUSIONS: Inter-rater agreement for all assessments showed variability between lung regions but maintained reasonable percentage agreement in mechanically ventilated participants. The level of percentage agreement achieved between clinicians did not directly relate to clinical experience for all respiratory assessments. Therefore, these respiratory assessments should not necessarily be viewed in isolation but interpreted within the context of a full clinical assessment.

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Lung sound intensity in patients with emphysema and in normal subjects at standardised airflows.

Cited by 42 publications

References 31 publications

Lung sounds in asbestos induced pulmonary disorders

Lung sounds in asbestos induced pulmonary disorders

Breath Sound Intensity during Tidal Breathing in COPD Patients

Inter-Rater Agreement of Auscultation, Palpable Fremitus, and Ventilator Waveform Sawtooth Patterns Between Clinicians

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