Bronchospasm

Bronchospasm is when the bronchi are narrowed by either constriction of bronchial muscle, and/or swelling / mucus inside.ย  See Lower Respiratory Tract, Diagram D (Asthma / Bronchospasm) for a picture-worth-a-whole-bunch-of-words.ย 

Disease wich cause Bronchospasm include:

How does bronchospasm sound through a stethoscope?

  • Wheezes (long, high-pitched sounds during expiration)
  • Rhonchi (squeaks / gurgles, during inspiration or expiration)
  • Long Expiratory Phase

Problem!  Clinicians all know that wheezes mean bronchospasm.  But some donโ€™t realize that rhonchi do also.  And quite a number fail to appreciate that bronchospasm may declare itself with โ€œclear lungs,โ€ but a long expiratory phase.  Think of how we sound when we breathe normally: a brief breath in, then exhale, and pause before the next breath.

This โ€œexhale + pauseโ€ looks longer than the breath in, when simply watching someone from the outside.  But listening to the inside of the lungs with a stethoscope, itโ€™s the opposite: inspiration normally sounds longer than expiration, because the pause sounds silent.  However, with bronchospasm, we hear the high-pitched wheeze of struggled expiration all through the pause; if the pitch is too high, we canโ€™t hear the sound itself, just the time it occupies (unless weโ€™re a dog).

If you ever get seen for a cough, and your provider tells you, โ€œThe lungs are clear,โ€ be sure to ask, โ€œDoes inspiration sound longer than expiration?โ€ย  If not, and the normal ratio of inspiration-to-expiration is reversed, then itโ€™s bronchospasm

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