12 July

Emphysema Lung Sounds: Wheezing, Crackling, and More

The respiratory sounds our lungs make can tell us a great deal about how they are functioning (or more likely malfunctioning, as in most cases where there is an unusual noise).

Doctors are trained to understand these different sounds as heard through a stethoscope, and the presence of certain respiratory sounds may lead them to order additional tests to determine the specific nature of the lung issue.

Not every instance of wheezing, for example, means a serious or life-threatening condition is present. Nevertheless, many people experience wheezing at some point in their lives, whether it is connected to a seasonal allergy or associated with a temporary bout of bronchitis.

However, consistent wheezing accompanied by other lung sounds and difficulty breathing may indicate emphysema.

You should contact your doctor to discuss any concerns you have with your lung sound, breath sound, and other breathing issues or respiratory distress you may be experiencing.

highlighted green lung infected with virus

To understand these abnormal breath sounds, and the way physicians describe them, we have outlined them here, along with some information about emphysema testing and treatment.

What is Emphysema?

Emphysema occurs when air sacs around the lungs are damaged and weakened, resulting in shortness of breath. While it is most often associated with smokers, it is also possible for non-smokers to develop emphysema from exposure to air pollution or chemical fumes and dust.

When emphysema is present, there is often chronic bronchitis as well, and these two conditions coupled together become what is known as COPD, or chronic obstructive pulmonary disease.

Seven Types of Lung Sounds

Emphysema, chronic bronchitis, and COPD can result in a number of different sounds coming from your lungs, and we will break those down for you here. The seven sounds you (or your physician) may hear are labeled as:

  • Crackling
  • Hamman’s sign
  • Pleural friction rub
  • Rhonchi
  • Stridor
  • Wheezing
  • Whooping

The presence of any one of these sounds or a combination of them will give your doctor an idea of what sort of lung issue may be present. However, a diagnosis would not be made based on a sound alone.

Other physical symptoms will play a part in diagnosing your condition, and a doctor may want to look at various tests to better understand how your lungs may be affected.

The sounds do give doctors a good jumping-off point for diagnosis and treatment, so we will review each type below.

Crackling

If you think about what a crackling fire sounds like, you know that there is an occasional popping sound. This is no different from crackling lungs.

Also known as rales, crackles in the lungs create popping and clicking noises as you inhale, and your physician will be able to detect this sound with a stethoscope. The cause of this noise is when an air bubble passed through fluid, and a cough can ultimately break up the fluid and make the sound go away.

Healthcare professionals will further classify them into three specific types: fine, coarse, and biphasic when listening for crackles.

Fine crackles may tell your physician that you have some fluid in small airways, and these could be indicative of pneumonia or congestive heart failure. They will create a high-pitched sound through a stethoscope and happen quickly.

On the other hand, coarse crackling will result in a sound that is both longer and deeper. This type of crackle is associated with larger airways and usually indicates the presence of COPD.

Biphasic crackling refers to the combination of both coarse and fine crackles.

doctor checking patient

Hamman’s Sign

If your healthcare provider mentions she hears Hamman’s sign, she has heard a sound that occurs simultaneously with your heartbeat.

This particular sound is the result of air being trapped in your mediastinum, which is simply the space between your lungs.

Hamman’s sign is described as a sort of crunching sound, and its presence tells medical providers that there is some type of damage to your lungs or windpipe.

You might think of this sound the same way you would if you saw a less than fully inflated tire: you know that the tire is letting air escape to where it should not be (outside the tire), and in the case of your lungs, the air is “escaping” to the mediastinum. 

Pleural Friction Rub

You have likely seen “pleural” used in conjunction with lung-related medical terminology before, but you may not know exactly what it means. Pleura refers to thin membranes covering the lungs.

These membranes slide over one another and regulate the way we breathe. While this process is normally smooth, inflammation from COPD can cause them to rub against each other and generate an explosive sound, described by your doctor as a pleural friction rub.

Rhonchi

Rhonchi sounds are similar to wheezing in that they are continuous sounds in the lungs; however, a rhonchus will have a lower pitch than what you would associate with wheezing.

When medical professionals detect rhonchi, they are alerted to the presence of fluid in larger airways. This type of lung sound is commonly associated with COPD.

Stridor

This is another lung-related noise that the average person might hear through a stethoscope and say, “that sounds like wheezing.” Stridor is certainly similar to wheezing, with one main difference: it is louder. 

This is a sound that can be produced whether you are inhaling or exhaling, and stridor can be caused if your airway is narrowed or if you are experiencing some kind of blockage.

A medical professional will observe whether the sound is happening as you inhale or exhale. If the noise is detected when you breathe in, the likely cause is a blockage of some sort of narrowing above your larynx. Stridor that occurs as a patient exhales signals a narrowing in the trachea.

Wheezing

One way to determine if the lung sound is wheezing is if it produces a sort of whistling noise. Wheezing is a high-pitched sound, and it can be heard while you breathe in and out (though it is likely louder as you exhale).

Wheezing occurs with emphysema and COPD because of inflammation in your airways, and it is also commonly associated with asthma.

Whooping

women with cold and flu

Perhaps there is no more distinctive lung sound than whooping, which most people associated with pertussis, or “whooping cough.” This sound is created as we gasp for air.

Those with COPD are more susceptible to pertussis, which is caused by bacteria. COPD patients who suspect they may have pertussis should contact their physicians for the best course of treatment.

Additional Testing Related to Lung Sounds

Some of the sounds described above can be detected by ear. For example, you may be able to hear someone next to you wheezing with the unmistakable whistling sound that occurs.

However, the majority of these lung sounds will be heard through a stethoscope.

Depending on what is heard through the stethoscope, your physician may order more tests to determine the best course of treatment for your specific condition.

These tests may include:

  • Bronchoscopy: In this test, a small scope is used to allow a medical professional to examine your lungs.
  • Chest X-ray: this image can reveal damage to the lungs' air sacs, which occurs with COPD and emphysema.
  • CT scan: this scan provides even more detail than a chest X-ray. It can be useful in diagnosing a variety of conditions that may be affecting the lungs.
  • Laryngoscopy: In this test, a small scope is used to allow a medical professional to examine your larynx (or voice box).
  • Spirometry: A small device (spirometer) is used to test your lung volume and airflow.

Courses of Treatment for Emphysema and COPD

You should always consult your physician before trying any new treatment plan to manage emphysema and COPD. The treatments listed below cover some of the most commonly used methods, and your own medical team will know the best combination of treatments for your particular health concerns and history.

The universally agreed first step when it comes to emphysema lung sound and COPD is quitting cigarette smoking. After that, you may also be advised to consider:

Corticosteroids: This medication, which can be taken orally or through an inhaler, can ease swelling and inflammation in the body, making it effective in working against COPD flareups.

Phosphodiesterase-4 inhibitors: These are also referred to simply as PDE4 inhibitors; this is a newer class of medicines available to treat COPD. These oral medications have anti-inflammatory effects helpful in treating lung conditions.

Mucolytics: As the name implies, this medication treats mucus. Specifically, it thins out the mucus that can make it difficult for those with emphysema and COPD to breathe.

Supplemental Oxygen: Because breathing can be difficult with COPD and emphysema, sometimes supplemental oxygen therapy, delivered through a mask or nose prongs, brings great relief to a COPD patient.