Inflammation affecting the lung tissue is diagnosed by different methods: clinical, radiological, laboratory. One of the characteristic manifestations of pathology is the appearance of respiratory noises, which are absent if the respiratory organs are healthy. The different nature of wheezing in pneumonia indicates the course of a pathological process.
Basic breathing noise
Air always passes through the airways with a certain sound, not soundless. These are basic or fundamental noises. If side sounds are heard, which should not be normal, the doctor understands that changes have occurred in the respiratory system, provoked by pathology.
If the person is healthy, a type of breathing called vesicular is heard. It is heard as the sound “fe”, increasing all the time, while the inhalation lasts, and about a third of the exhalation. This type of breathing can also be heard with pneumonia, when listening to areas not affected by pathology.
With pneumonia, breathing is usually impaired. This is due to the fact that the lungs are not sufficiently ventilated, letting in smaller volumes of air.
When inflammation progresses in the lungs, the patient’s breathing becomes hard: the noise of air passing increases, a sound is heard throughout the entire time the exhalation continues. Hard and uneven breathing indicates that in addition to inflammation of the lung tissue, the bronchial tree is affected: its branches are pathologically narrowed and inflamed.
Types of wheezing with pneumonia
In addition to the main breathing, during auscultation, other noises are also heard, indicating that the lungs are affected by a pathological process. With pneumonia, they are of the following types:
- wheezing (dry or wet);
- pleural rubbing sounds.
Wheezing is the sound that occurs in the airways when an air stream is passed through them, due to uneven swelling of the mucous membranes, obstruction, fluctuations in exudate, mucus and other fluids. If the respiratory organs are healthy, such noises are absent, they occur only in the presence of a disease. They are classified as dry or wet. Depending on how large the bronchus is, fine, medium and large bubbling wet rales are emitted. Dry wheezes are distinguished by their tonality into bass and treble.
Pneumonia in most cases is accompanied by just moist wheezing. Their occurrence is due to the passage of air through cavities filled with large volumes of sputum. Such wheezing is pronounced, reminiscent of a gurgling sound. They are audible not only over focal lesions, but also when listening to the entire lung cavity both in the inhalation phase and during exhalation. The highest strength is reached at the peak of inhalation.
Sputum in the lungs
Sometimes sounds are heard even at some distance from a person, without a stethoscope. After coughing up sputum, the airways remain free for a period of time, moist rales are not heard.
In the typical course of the disease, sputum begins to form in large volumes around the third day. During this period, wet wheezing occurs. In some cases, coughing and wheezing persist for about 10-15 days after acute symptoms have subsided. This is due to the fact that phlegm is still being produced. Its production gradually fades away, and the symptoms disappear completely.
This type of pathological murmurs is observed with pneumonia less often, usually on the first day or on the second from the onset of the pathological process. The onset of sound occurs in the bronchial tree. The bronchi are filled with thick phlegm, passing through which the air swirls. The smaller the bronchus in which this occurs, the higher the audible sound. Bass wheezing occurs in the large bronchi. These noises are quite quiet and require a stethoscope to be heard. If the bronchi are severely narrowed, dry wheezing can be heard without a device, like a quiet squeak at the end of exhalation.
Pleural rubbing sound
Inflammation of the pleura
If pneumonia is complicated by the addition of inflammation of the pleura (smooth serous membrane of the lungs), along with wheezing, the noise of its friction is also heard. Normally, the pleural sheets are smooth, with the development of inflammation, they lose this property. The sound resembles a quiet creak of snow, is heard in both phases of breathing, does not change after coughing, tends to increase when the stethoscope is pressed on the listening area.
With pneumonia, exudate is formed in the alveoli, and the parameters of the surfactant change . Because of this, the alveoli collapse , and in the final phase of inhalation they open sharply. This is the reason for the sound that resembles a crunch or crackle, called crepitus. Noises of this type become audible approximately on the second day of the development of inflammation and completely disappear after recovery.
If the doctor detects abnormal murmurs during auscultation, he may conduct additional research. Bronchophonia is a technique in which a specialist asks the patient to whisper words containing hissing sounds, while listening to the chest with a stethoscope. If the lung tissues are healthy, sounds are heard, but it is impossible to hear the spoken phrase. If the inflammatory process provoked the formation of seals, the words are heard clearly.
If pneumonia is complicated by atelectasis, emphysema, pneumothorax, exudative pleurisy, bronchophonia is weakened (words are not heard clearly, the sound is poorly conducted). Enhanced bronchophonia is observed with an uncomplicated course of pneumonia, with a burst lung abscess, lung infarction.
X-ray of the lungs
The main research method that makes it possible to make an accurate diagnosis of pneumonia is X-ray of the lungs. However, before sending a person for such an examination, a therapist or pulmonologist conducts an analysis of the patient’s complaints and a clinical examination, including the use of auscultation and percussion methods. It is the data obtained during the initial examination that suggest the presence of an inflammatory process in the lungs and send the patient for further examination.
Percussion is a technique in which the doctor taps his fingers on certain areas of the chest or back in the projection of the lungs and analyzes the sounds that occur during this. Experts know what the sound should be, and by changing it, they draw conclusions about the presence of inflammation. When one finger strikes the other, placed on a certain area of the chest, a sound is heard that is characteristic of the lungs, that is, organs filled with air. If there are seals in the lung tissues resulting from inflammation, the doctor hears a dull, less sonorous sound.
Auscultation is a method of listening to various sounds that occur when air passes through the airways. Tapped the lungs using a special device – a stethoscope or Phonendoscopes .
Wheezing and coughing after pneumonia
At the end of treatment, when the temperature returns to normal, the fever disappears, wheezing after pneumonia may persist for some time. If the radiological signs of the inflammatory process have already disappeared, the doctor said that the patient is healthy, there are so-called residual effects. This is due to the fact that the respiratory system takes some time to restore normal structure and functionality.
If wheezing, whistling, and other side noises are heard for a long time after recovery, you should consult a doctor and be examined. Pathological sounds that go beyond the normal breathing noise can be a symptom of various pathologies: spasm of the bronchi, diseases of the larynx, the presence of a foreign body in the airways. In additi