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

BACKGROUND: A common auscultatory finding in pulmonary emphysema is a reduction of lung sounds. This might be due to a reduction in the generation of sounds due to the accompanying airflow limitation or to poor transmission of sounds due to destruction of parenchyma. Lung sound intensity was investigated in normal and emphysematous subjects in relation to airflow. METHODS: Eight normal men (45-63 years, FEV1 79-126% predicted) and nine men with severe emphysema (50-70 years, FEV1 14-63% predicted) participated in the study. Emphysema was diagnosed according to pulmonary history, results of lung function tests, and radiographic criteria. All subjects underwent phonopneumography during standardised breathing manoeuvres between 0.5 and 2 1 below total lung capacity with inspiratory and expiratory target airflows of 2 and 1 l/s respectively during 50 seconds. The synchronous measurements included airflow at the mouth and lung volume changes, and lung sounds at four locations on the right chest wall. For each microphone airflow dependent power spectra were computed by using fast Fourier transformation. Lung sound intensity was expressed as log power (in dB) at 200 Hz at inspiratory flow rates of 1 and 2 l/s and at an expiratory flow rate of 1 l/s. RESULTS: Lung sound intensity was well repeatable on two separate days, the intraclass correlation coefficient ranging from 0.77 to 0.94 between the four microphones. The intensity was strongly influenced by microphone location and airflow. There was, however, no significant difference in lung sound intensity at any flow rate between the normal and the emphysema group. CONCLUSION: Airflow standardised lung sound intensity does not differ between normal and emphysematous subjects. This suggests that the auscultatory finding of diminished breath sounds during the regular physical examination in patients with emphysema is due predominantly to airflow limitation.

[1]  M Turner-Warwick,et al.  Breath sounds in emphysema. , 1969, British journal of diseases of the chest.

[2]  Thurlbeck Wm.  Pathophysiology of chronic obstructive pulmonary disease. , 1990 .

[3]  A. E. Anderson,et al.  Further observations on luminal deformity and stenosis of nonrespiratory bronchioles in pulmonary emphysema. , 1977, Thorax.

[4]  J. Hardin,et al.  Monitoring the state of the human airways by analysis of respiratory sound. , 1979, Acta astronautica.

[5]  W M Thurlbeck,et al.  Radiographic appearance of the chest in emphysema. , 1978, AJR. American journal of roentgenology.

[6]  S. Kraman,et al.  Vesicular lung sound amplitude mapping by automated flow-gated phonopneumography. , 1982, Journal of applied physiology: respiratory, environmental and exercise physiology.

[7]  S. Kraman,et al.  The forced expiratory wheeze. Its site of origin and possible association with lung compliance. , 1983, Respiration; international review of thoracic diseases.

[8]  J. Tienari,et al.  Diagnosis of emphysema on chest radiographs. , 1984, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[9]  P. Macklem,et al.  Correlation of regional breath sound with regional ventilation in emphysema. , 1982, The American review of respiratory disease.

[10]  R Spagnolo,et al.  A computer system for timing and acoustical analysis of crackles: a study in cryptogenic fibrosing alveolitis. , 1984, Bulletin europeen de physiopathologie respiratoire.

[11]  Steve S. Kraman,et al.  Vesicular (Normal) Lung Sounds: How Are They Made, Where Do They Come from, and What Do They Mean? , 1985 .

[12]  P. Macklem,et al.  Breath sounds and distribution of pulmonary ventilation. , 1970, The American review of respiratory disease.

[13]  H S Hira,et al.  LUNG SOUNDS , 1978, The Journal of the Association of Physicians of India.

[14]  C. J. Martin,et al.  A test of the practical value of estimating breath sound intensity. Breath sounds related to measured ventilatory function. , 1976, Chest.

[15]  S. Kraman,et al.  Effects of lung volume and airflow on the frequency spectrum of vesicular lung sounds. , 1986, Respiration physiology.

[16]  W. F. Anderson,et al.  Frequency analysis of breath sounds by phonopneumography. , 1981, Medical instrumentation.

[17]  S. Kraman,et al.  The relationship between airflow and lung sound amplitude in normal subjects. , 1984, Chest.

[18]  D A Rice,et al.  Sound speed in pulmonary parenchyma. , 1983, Journal of applied physiology: respiratory, environmental and exercise physiology.

[19]  A. Miller,et al.  Standardized lung function testing. , 1984, Bulletin europeen de physiopathologie respiratoire.

[20]  J. Grotberg,et al.  Fluid-dynamic flapping of a collapsible channel: sound generation and flow limitation. , 1980, Journal of biomechanics.

[21]  S. Kraman,et al.  Does the vesicular lung sound come only from the lungs? , 1983, The American review of respiratory disease.

[22]  S. Kraman,et al.  Lung sound intensity variability in normal men. A contour phonopneumographic study. , 1983, Chest.

[23]  Steve S. Kraman,et al.  The Forced Expiratory Wheeze , 1983 .

[24]  W. J. Langford.  Statistical Methods , 1959, Nature.

[25]  Phillips Yy,et al.  Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, November 1986. , 1987, The American review of respiratory disease.

[26]  S. Kraman,et al.  Airflow-generated sound in a hollow canine airway cast. , 1990, Chest.

[27]  Jeffrey R. Hammersley,et al.  Mechanisms of Lung Sound Generation , 1985 .

[28]  A. E. Anderson,et al.  Small airways in severe panlobular emphysema: mural thickening and premature closure. , 2015, The American review of respiratory disease.

[29]  R. Peslin,et al.  Breath sounds in the clinical assessment of airflow obstruction. , 1978, Thorax.

[30]  D. Niewoehner.  New Messages from Morphometric Studies of Chronic Obstructive Pulmonary Disease , 1986 .

[31]  Lung Sounds in Patients with Emphysema1–3 , 1981 .

[32]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.