- wheezes, steady high-pitched whistling noise
heard with exhalation that is typical of
obstructed airways such as might result with
ASTHMA, inhaled foreign objects, CHRONIC
OBSTRUCTIVE PULMONARY DISEASE (COPD), and
chronic BRONCHITIS - rales (also called crackles), intermittent crack-
ling noises that may sound fine (like crinkling
cellophane) or coarse (like pulling apart a hook
and loop fastener) often heard with ACUTE RESPI-
RATORY DISTRESS SYNDROME (ARDS), PULMONARY
EDEMA, BRONCHIECTASIS, and INTERSTITIAL LUNG DIS-
ORDERS - rhonchi, low-pitched, continuous whistling
noises heard with exhalation that suggest air-
ways blocked with mucus - stridor, loud wheezing sounds heard with inspi-
ration when there is an obstruction of the tra-
chea
Stridor is a life-threatening emergency
that requires immediate medical atten-
tion.- pleural rub, brushing sounds that indicate
INFLAMMATIONof the PLEURA(membrane cover-
ing the outer surfaces of the lungs) such as
occurs with PLEURAL EFFUSIONor pleural fibrosis
Breath sounds present important diagnostic
information that helps the doctor determine the
health status of the lungs as well as assess the
progress of conditions under treatment.
See also EPIGLOTTITIS; HEART SOUNDS.
bronchiectasis The dilation of a segment of
BRONCHUS. Bronchiectasis may involve several
bronchial branches and usually occurs deep
within the lung, often in a lower lobe. Though
bronchiectasis may be congenital (present at birth)
or acquired (develop after birth), congenital
bronchiectasis is rare and results when only the
core structure of the LUNGSdevelops and existing
bronchi dilate in reaction to the pressure of
incoming air. Acquired bronchiectasis commonly
develops with chronic lung INFLAMMATIONsuch as
results from CYSTIC FIBROSISor repeated INFECTION
(typically chronic BRONCHITIS).
Bronchiectasis represents permanent damage to
lung tissue, often with accompanying PULMONARY
FIBROSIS(scarring), and loss of lung function in the
affected areas. Because of the lung’s segmented
structure nonaffected segments and lobes of the
lung continue to function normally, so the extent
to which the bronchiectasis affects respiratory per-
formance depends on the number of segments
involved. However, bronchiectasis tends to be pro-
gressive.
Suspicion of bronchiectasis becomes valid with
the existence of pulmonary conditions known to
be predisposing, such as cystic fibrosis and chronic
bronchitis. Bronchiectasis may follow recurrent
PNEUMONIA, ASPIRATIONpneumonia, childhood dis-
eases such as PERTUSSIS(whooping COUGH) in chil-
dren who have not received IMMUNIZATION, and
toxic inhalation (such as smoke or chemical
inhalation). IMMUNODEFICIENCY disorders that
increase the risk for pulmonary infections also
raise the likelihood of bronchiectasis. Symptoms
typically develop over months to years and com-
monly include- persistent, productive cough more intense in
the mornings and just before going to bed - prodigious SPUTUMproduction
- HEMOPTYSIS(BLOODin the sputum)
- wheezing (high-pitched, abnormal BREATH
SOUNDSwith exhalation)
The diagnostic path includes chest X-rays and
COMPUTED TOMOGRAPHY(CT) SCAN. The doctor may
further desire BRONCHOALVEOLAR LAVAGE or
bronchial biopsy (via BRONCHOSCOPY), sputum cul-
tures, and blood tests. Treatment depends on the
findings and may include ANTIBIOTIC MEDICATIONSto
treat infections or CORTICOSTEROID MEDICATIONS to
treat severe inflammation. Bronchodilator med-
ications may help relax and open undamaged
bronchi to improve lung capacity. CHEST PERCUS-
SION AND POSTURAL DRAINAGEhelp loosen mucus so
the normal mechanisms of the respiratory tract
can move it out of the lungs. Rarely, surgery to
remove a particularly eroded or chronically
infected bronchial segment is necessary. Most peo-
ple are able to manage bronchiectasis with regular
medical evaluation and care (including prompt
treatment at the earliest indication of infection).bronchiectasis 195