Wheezing

Wheezing is a pathological breathing noises. On the mechanism of occurrence of wheezing and sound feeling we get when listening, wheezing divided into dry and wet.
Moist rales occur, if in the bronchi accumulated fluid (liquid secret or blood); passing air jet spanaway accumulated liquid formed on its surface bubbles burst and ears explores how moist rales. When fluid buildup in the bronchioles and small bronchi (pneumonia, bronchiolitis) are heard fine basal rales; if liquid secret or blood contained in the bronchi medium-to large-caliber (bronchitis, pulmonary edema) or in the corresponding size cavities (bronchiectasis, abscess cavity), heard a medium to large bubble wheezing. Should be differentiated fine basal rales from creditarii (see). When sealing the lung tissue around the cavity moist rales become audible.
Dry rales arise in violation of bronchial obstruction (spasm of the bronchi, deformation or compression, swelling of the mucous membrane of the bronchi or accumulation in them viscous sputum). Their formation is connected with the whirling air movements in places narrowing.
Buzzing (bass) dry rales are formed in large bronchi, whistling in the bronchi small calibre, the bronchioles.
With extensive violations of bronchial passability dry wheezing heard above all pulmonary fields (for example, bronchial asthma, bronchitis).
The constancy of dry rales over by any stretch of the lung tissue is a symptom of local inflammatory lesion or tumor, causing reduced clearance bronchi.

Wheezing (rhonclii) - abnormal breathing noises that occur in the bronchi, trachea, and in pathological lung cavities (the abscess cavity, bronchiectasis). In the absence of cavities in the lungs, the emergence of wheezing evidence of breaking of bronchial obstruction. There are dry and moist rales.
Dry rales have a common mechanism of formation - the narrowing of the bronchial arising from bronchial spasms (bronchial asthma), swelling of the mucous membrane of the bronchi (inflammation, allergic reactions), in the presence of viscous mucus secretion, sticking to the walls of the bronchi
(bronchitis), with an increase of bronchial tumors or compression of the bronchus from the outside (a tumor, enlarged lymph node, the inflammatory process). In areas of narrowing of the bronchi passing the air makes additional whirling motion, which cause the appearance of dry rales. Dry rales are heard during inhalation and exhalation. Depending on the width of the lumen and the degree of narrowing of the bronchi there are high (treble) - whistling and low, humming - bass wheezing. Higher dry rales (rhonchi sibilantes) occur in small bronchi and lower (rlionchi sonores) - in a major. Dry rales show a large variability: in a short period of time and on the same plot their number can be increased, then reduced, they can disappear and reappear. When coughing viscous secret moves from one bronchus to another, so rales can change your character to disappear in the place they were heard to cough, and to appear there where them to cough was not. This allows you to distinguish them from other extension respiratory noise (creditarii, noise pleural friction)that when coughing are not changed. The more energetically movement in the bronchi of the masses, the louder wheezing. As with a deep breath the air speed in the bronchi increases, increases the amplitude of fluctuations and increases the volume of wheezing. So when listening to want to force the patient to breathe deeper. When exhaling the speed of air flow in the bronchi less than in the breath, so during the expiratory rales are heard less often than in the breath. The exception is bronchial asthma, when dry rales heard mostly during exhalation.
Persistent dry rales on a plot of lung tissue are of great diagnostic value, as they are a symptom of local inflammatory lesion or tumor in the lung, which reduce the clearance of the bronchus.
Moist rales arise in the bronchi and abnormal lung cavities in case they contained the secret is a liquid consistence (liquid sputum, exudate or transudate, blood). They resemble the sound of bursting bubbles in the water of the air blown through a straw. In most cases, the mechanism of occurrence of moist rales are so. Air passing when you inhale and exhale through the fluid that fills the bronchus, spanaway her. The bubbles rising to the surface of the liquid burst and perceived that comes from listening to how moist rales. According to B. C. the Shklyar, described the mechanism of occurrence of moist rales can be only in case if the content of the bronchi completely liquid. If the mass contained in the bronchi, semi-liquid (thick sputum), it is difficult to avoid the possibility of passing through them with air bubbles. In these cases, it seems, front air jet is formed semi-liquid film, which, Nativas, gradually becomes thinner and bursts, making the sound perceived as a wet sound.
The magnitude of the resulting air bubbles depends on the strength of the movement of air stream, its speed, number of secret and mainly on the width of the bronchi clearance or diameter of pathological cavities. When listening to some of the moist rales resemble the sound of bursting smaller bubbles, others larger. So moist rales divided into large, medium and fine bubble. Large bubble rattles are in large bronchi in pulmonary edema and pathological cavities. Tracheal seething wheezing usually appear in severe condition of the patient when he is not able to cough phlegm from the trachea. Such wheezing is often heard in the period of agony. The emergence of large bubble of wheezing over peripheral lungs, where there are no large bronchi, may indicate the formation of a cavity.
Srednepuzyrchatye wet wheezing formed in the bronchi of average size and are a sign of bronchitis or appear stagnant phenomena in small circulation.
Fine bubble moist rales occur in small or very small bronchi inflammation of the mucous membrane of the last (bronchitis, bronchiolitis). Small bronchi are often involved in the inflammatory process in the defeat of light, so wet fine basal rales are often defined in focal pneumonia. The presence of damp small - and medium-bubble-crackles both lungs are often associated with circulatory failure, which develops the stagnation of blood in the pulmonary circulation (heart diseases, cardiosclerosis, cardiac asthma).
Moist rales divided into sonorous and not euphonic. Sonority of wheezing depends on the degree of holding sounds easy and the availability of resonance. For reinforcement of the conduction of the lungs (seal) and especially in the presence of a resonance chamber moist rales become audible. At cavities sonorous moist rales often have a metal shade. This contributes surrounding the cavity densified lung tissue, increasing resonance.
Not euphonic moist rales are heard in bronchitis, stagnation in the lung. Should be differentiated fine basal rales from creditarii (see) and noise pleural friction. Fine bubble moist rales of different times are heard in both phases of breath, while crepitus shall be heard only at the height of inspiration in the form of "explosion". Moist rales change after coughing (increase, decrease, change their localization), and crepitus is not changed. To distinguish noise pleural friction from moist rales ask the patient to cough while wheezing change, and noise pleural friction is not changed, ask the person to close your mouth and hold your nose, and then drag and bulging belly - noise pleural friction shall be heard, and wheeze there is an inflow of air. When breathing noise pleural friction often
accompanied by pain in the corresponding half of the thorax, which is not the case with wheezing.