Prevalence and clinical associations of wheezes and crackles in the general population: the Tromsø study

Abstract

Background Wheezes and crackles are well-known signs of lung diseases, but can also be heard in apparently healthy adults. However, their prevalence in a general population has been sparsely described. The objective of this study was to determine the prevalence of wheezes and crackles in a large general adult population and explore associations with self-reported disease, smoking status and lung function. Methods We recorded lung sounds in 4033 individuals 40 years or older and collected information on self-reported disease. Pulse oximetry and spirometry were carried out. We estimated age-standardized prevalence of wheezes and crackles and associations between wheezes and crackles and variables of interest were analyzed with univariable and multivariable logistic regressions. Results Twenty-eight percent of individuals had wheezes or crackles. The age-standardized prevalence of wheezes was 18.6% in women and 15.3% in men, and of crackles, 10.8 and 9.4%, respectively. Wheezes were mostly found during expiration and crackles during inspiration. Significant predictors of expiratory wheezes in multivariable analyses were age (10 years increase - OR 1.18, 95%CI 1.09–1.30), female gender (1.45, 1.2–1.8), self-reported asthma (1.36, 1.00–1.83), and current smoking (1.70, 1.28–2.23). The most important predictors of inspiratory crackles were age (1.76, 1.57–1.99), current smoking, (1.94, 1.40–2.69), mMRC ≥2 (1.79, 1.18–2.65), SpO2 (0.88, 0.81–0.96), and FEV1 Z-score (0.86, 0.77–0.95). Conclusions Nearly over a quarter of adults present adventitious lung sounds on auscultation. Age was the most important predictor of adventitious sounds, particularly crackles. The adventitious sounds were also associated with self-reported disease, current smoking and measures of lung function. The presence of findings in two or more auscultation sites was associated with a higher risk of decreased lung function than solitary findings.

Prediction of chronic heart failure and chronic obstructive pulmonary disease in a general population: the Tromsø study

“…Hearing crackles (any or basal) was not a significant independent predictor of COPD in the multivariable analysis, which may partly be explained by frequent occurrence of crackles among current smokers. 11 Wheezes were confirmed to be independent predictors of COPD. 21 ROC analyses showed that HF and COPD can be identified with similar ease based on history, symptoms, and signs.…”

“…Lung sounds were recorded at six locations of the chest, 15 s at each site, with a Sennheiser microphone inserted in the tube of a Littmann Classic II stethoscope. Presence of wheezes and crackles (also called rales or crepitations) during inspiration and expiration was determined by clinicians independently classifying the recordings blinded for other information; details on recording sites and classification of the sounds have recently been published 11 . Basal inspiratory crackles heard bilaterally were a category used in the analysis 17 …”

“…Presence of wheezes and crackles (also called rales or crepitations) during inspiration and expiration was determined by clinicians independently classifying the recordings blinded for other information; details on recording sites and classification of the sounds have recently been published. 11 Basal inspiratory crackles heard bilaterally were a category used in the analysis. 17 Definition of heart failure and chronic obstructive pulmonary disease Heart failure was defined according to the latest European Society of Cardiology (ESC) guidelines 2 into three types: heart failure with reduced ejection fraction (HFrEF) characterized by LVEF <40% and presence of dyspnoea (mMRC ≥1); heart failure with mid-range ejection fraction (HFmrEF) with LVEF 40-49%, dyspnoea, serum NT-proBNP >125 pg/mL, and any of the following: structural heart disease/diastolic dysfunction; and heart failure with preserved ejection fraction (HFpEF) with LVEF ≥50%, dyspnoea, serum NT-proBNP >125 pg/mL, and any of the following: structural heart disease/diastolic dysfunction.…”

“…6,10 This study is based on the seventh survey of the Tromsø study where recording of lung sounds was included among the clinical investigations. 11 The aim of this study was to determine how abnormal lung sounds and respiratory symptoms, shortness of breath in particular, may predict HF and COPD, as identified by current guidelines and to what extent the occurrence of these diseases overlap in a general population.…”

Characteristics of Pulmonary Auscultation in Patients with 2019 Novel Coronavirus in China

“…A patient with rheumatoid arthritis was likely to have interstitial abnormalities, increasing the prevalence of Velcro crackles. Also, age and smoking status may be factors associated with adventitious sounds [21]. Second, present cross-sectional design did not allow a comprehensive characterization of the study population and final clinical outcomes.…”