Dr Mark Rosenthal

MD MB ChB FRCP FRCPCH BSc

Consultant in Paediatric Respiratory Medicine

also specialist in Food Allergies & Disorders of Sleep

A | A | A

T: 0207 351 8832

E: s.harvey@rbht.nhs.uk

A:The Royal Brompton Hospital, London, SW3 6NP

Abnormal Sounds from The Lungs and Respiratory System

Generally speaking excluding obscure things, there are only 4 sounds a lung makes.

Coughing

Which everybody understands. Within coughing there is dry coughing, wet coughing, barking coughing a bit like a dog, honking coughing a bit like a seal, bovine coughing (like a cow)  without that staccato sound and coughing ending in a breathing in whoop as in whooping cough. There can be several combinations.

Stridor

This a breathing IN sound, rising in pitch from beginning to end, indicating a problem from the tip of the nose in theory to about 4 or 5 centimetres below the voice box most commonly in the voice box itself especially croup or more properly laryngotracheobronchitis, a common almost always virally caused  illness of toddlers often coming on in the evening or early night. A variation is spasmodic croup in older children usually aged more than 5 years of very sudden onset often between 11pm and midnight without seemingly a viral preceding illness. This is sometimes called croup variant asthma and many go on to develop more conventional asthma symptoms  - please see section of asthma.

Wheezing

This is a breathing OUT sound, sighing or whistling in nature falling in pitch from beginning to end. In small children it is often accompanied by recession, a pulling in of the skin below, between and/or above the ribcage. It is due to a problem within the lung themselves as opposed to the voice box windpipe etc.  The commonest reasons are asthma or viral related symptoms.  You can have stridor and wheezing with laryngotraceobronchitis or perhaps if a child has inhaled a foreign body such as a small toy or peanut.

Stertor

A sort of gargling/purring sound which continues throughout the breathing cycle and is very often confused with wheezing. It is very common in children between the ages of 6 months and two years. Comes from above the voice box as if the child is blowing bubbles through milk with a straw but often felt as crackles with the hand on the rib cage even though it is NOT coming from the lung. It is very rare to be able to feel true lung crackles. Is worse with colds but in almost all cases should be regarded as a variation of normal.
 

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Dr Mark Rosenthal