Lung Sound Analysis Techniques
of the large degree of observer variability in clinical auscultation there
has been considerable interest in more objective methods of utilizing
the information provided by lung sounds. Summaries of the work done to
date can be found in two state of the art papers published by the American
Thoracic Society (16, 17). An extensive
bibliography is also available on the International Lung Sounds Association
Web site (18). Some of the more clinically
relevant reports are mentioned below.
Tape recordings and acoustic analysis have helped to clarify the previously
confused nomenclature (19). This has
been facilitated by International groups, particularly the International
Lung Sound Association and the CORSA group of the European Economic Community.
Tape recordings have been particularly useful in the educational process
and a number of tapes are commercially available.
There has also been a good deal of interest in computerized analysis of
lung sounds since the initial report in 1973 (14).
Several clinical applications have resulted. Screening for occupationally
related diseases has been demonstrated to be feasible using acoustic techniques
(20, 21). Screening for sleep apnea can
be done using lung sounds (22). Long
term monitoring of wheezing is now feasible and the instrumentation to
do this is now commercially available (23,
24). Lung sound analysis has been demonstrated to show the effects
of bronchoconstrictors and allergen induced asthmatic responses in patients
with asthma (25-28). This has distinct
advantages in subjects unable to perform pulmonary function tests properly,
particularly children. A detailed discussion of the numerous studies showing
the usefulness of this approach as well as its pitfalls has been presented
(29). Numerous investigators have presented
computerized methods for detection and quantification of lung sounds (30-32).
Some of these have been validated (33).
Pattern differences among the common lung diseases have been demonstrated
to be documented objectively with the aid of computers (34).
Despite the enormous potential, the applications of lung sound technology,
that are currently proven to be clinically useful, however, are relatively
few. In view of the recent advances in computer technology it is likely
that powerful diagnostic and monitoring devices will be available in the
Murphy, RLH, Holford, SK, Knowler, WC. Lung
sound characterizations by time expanded waveform analysis. New
Eng J Med 1977; 296:968.
Hoevers, Loudon, RG. Measuring crackles.
Chest 1990; 98:1240.
Murphy, RLH. Discontinuous adventitious lung
sounds. Sem in Resp Med 1985; 6:210.
Al Jarad, Davies SW, Logan-Sinclair R, Rudd M. Lung
crackle characteristics in patients with asbestosis-related pleural disease
and left ventricular failure using a time-expanded waveform analysis,
a comprehensive study. Respir Med 1994; 88:37.
Earis, E, Marsh, K, Pearson, MG, Ogilvie, CM. The
inspiratory "squawk" in extrinsic allergic alveolitis and other
pulmonary fibroses. Thorax 1982; 37:923.
Braughman, RP, Loudon, RG. Stidor: differentiation
from asthma or upper airway noise. Am Rev Respir Dis 1989; 139:1407.
Dodge, RR, Burrows, B. The prevalence and
incidence of asthma and asthma like symptoms in a general population sample.
Am Rev Respir Dis 1980; 122:567.
Goldman, L, cook, EF, Johnson, PA, et.al. Prediction
of the need for intensive care in patients who come to emergency departments
with acute chest pain. New Eng J Med 1996;334:1498-504.
Deguchi, F, Hirakawa, S, Gotoh,K, et al. Prognostic
significance of posturally induced crackles. Long term follow-up of patients
after recovery from acute myocardial infarction. Chest 103, 1457-1462
Wipf, JE, Benjamin, A, Lipsky, MD, et al. Diagnosisng
Pneumonia by physical examination. Relevant or relic. Arch Intern
Lal ,S, Ferguson, A D, Cambell,E J M Forced
expiratory time: A Simple Test for Airways Obstruction Brit Med
Walshaw, J, Nisar, M, Pearson, MG, et al. Expiratory
lung crackles in patients with fibrosing alveolitis. Chest 1990;
M.J. Walshaw, M. Nisar, M. G. Pearson, P. M. Calverley and 1. E. Earis
Expiratory lung crackles in patients with fibrosing
alveolitis. Chest 97, 407-409 (1990).
Murphy, RLH, Sorensen, K. Chest auscultation
in the diagnosis of asbestosis. J Occupational Med 1973; 15:272-276.
Baughman, RP, Shipley, RT, Loudon, RG, Lower, EE. Crackles
in Interstitial Lung Disease Comparison of Sarcoidosis Fibrosing Alveolitis
Loudon, RG, Murphy, RLH. State of the art:
Lung Sounds. Am Rev Resp. Med. 1985; 6:663.
Pasterkamp, H, Kraman, SS, Wodicka, GR. State
of the art: respiratory sounds: advances beyond the stethoscope.
Am J Respir Crit Care Med 1997; 156:974.
Cugel, D. Updated noenclature for membership
reaction. American Thoracic Society News Fall 1977-Vol. 3, No.
4, pp. 5,6.
Murphy, RLH, Gaensler, EA, Fitzgerald, M, et al. Diagnosis
of "asbestosis." Observations from a longitudinal survey of
shipyard pipe covers. Am J Med 1978; 65:488.
Gavriely, N, Nissan, DW, Cugell D, Rubin, AH. Respiratory
health screening using pulmonary function tests and lung sound analysis.
Eur Respir 1994;7:35.
Anderson, KS, Aitken, R, Carter, JES, et al. Variation
of breath sound and airway caliber induced by histamine challenge.
Am Rev Respir Dis 1990;141:1147.
Beck, RU, Dickson, MD, Montgomery, Mitchell, I. Histamine
challenge in younge children using computerized lung sounds analysis.
Malmberg, LP, Sorva, R, Sovijarvi, ARA. Frequency
distribution of breath sounds as an indicator of bronchoconstriction during
histamine challenge test in asthmatic children. Pediatr Pulmonol
Murphy, RLH. Chest ausculation in occupational
lung disease. Seminars in Resp Med 1986;7:254.
Bohadana, B, Kopferschmitt-Kubler, MC, Pauli, G. Breath
sound intensity in patients with airway provocation challenge test positive
by spirometry but negative for airflow obstruction in asthma. Chest
Sanchez, RE, Powell, Pasterkamp, H. Wheezing
and airflow obstrution during methacholine challenge in children with
cystic fibrosis and in normal children. Am Rev Respir Dis 1993;147:705.
Schreur, J, Diamant, Z, Vanderchoot, L, et al. Lung
sounds during allergen-induced asthmatic responses in patients with asthma.
Am Resp Crit Care Med 1996;153:1474.
Krumpe, PE, Cumminsky, JM. Use of laryngeal
sound recordings to monitor apnea. 1980;122:797.
Sanchez, IA, Avital, I, Wong, A, et al. Acoustic
vs. spirometric assessment of bronchial responsiveness to methacholine
in children. Pediatr Pulmonol 1993;15:28.
Gavriely, MD. Analysis of breath sounds in
bronchial provocation tests. Am J Respir Crit Care Med 1996;153:1469.
Murphy, RLH, Del Bono, E, Davidson, F. Validation
of an automatic crackle (rale) counter. Am Rev Respir Dis 1989;140:1017.
Kaisla, A. R. Sovijärvi, P. Piirilä, H. M. Rajala, S. Haltsonen
and T. Rosqvist Validated method for automatic
detection of lung sound crackles. Med. Biol. Eng. Comput. 29, 517-521
Malmberg, LP, Sovijarvi, ARA, Paajanen, E, et al. Changes
in frequency spectra of breath sounds during histamine challenge test
in adult asthmatics and healthy control substances. Chest 1994;105:122.