A rhonchi (also known as rales) is caused by thin or viscous secretions in the lungs. Sounds of varying character then occur in conjunction with breathing. The fluid retention can be caused by heart failure, inflammation or chronic lung disease.
What is a rhonchi sound?
A doctor notices the rhonchi sound when listening to the lungs if fluids or secretions have accumulated in the airways. The rhonchi is a sound that medical terminology refers to as a respiratory murmur. A doctor notices the sound when listening to the lungs if fluids or secretions have accumulated in the airways. During inhalation and exhalation, the movement of the fluids and secretions creates a sound that masks the breathing sounds of a healthy lung. The rattling sound has different characteristics depending on how viscous or thin the secretions are. Thin-bodied secretions produce discontinuous breath sounds, the characteristics of which are classified as large-breathed, medium-breathed, and small-breathed, as well as ringing, non-sounding, and metallic. Continuous breath by-products are produced by viscous secretions and include stridor, whistling/gurgling, and humming. Rales are often abbreviated as RG.
Causes
The cause of a rhonchi is an accumulation of fluids or secretions in the airways. These can enter the lungs due to a variety of conditions or dysfunctions. Pulmonary edema causes discontinuous breath sounds. Pulmonary edema results from either left heart failure, an inflammatory process, or poisoning. If the left side of the heart is weakened, it can no longer pump the blood coming from the lungs. Congestion occurs in the lungs, resulting in increased pressure on the pulmonary vessels. Fluid enters the lungs. Inflammatory processes, such as pneumonia, and poisoning can cause increased permeability of the blood vessels, so that fluid also enters the lung tissue. Fluid can also enter the lungs from the outside by being inhaled. The larger the fluid-filled portion of the lung, the more large-bubble the rales. Large-bubble RG occurs in pulmonary edema and bronchiectasis. The latter is an irreversible expansion of the bronchi that is filled with fluid. Bronchitis often causes medium-bubble rales, whereas pneumonia initially affects the alveoli and results in fine-bubble rales. The farther away the RG is from the physician’s stethoscope, the less it sounds. Fluid collections in the inner part of the lungs therefore produce non-sounding noises. Pneumothorax, a decreased or impossible expansion of the lungs, causes a metallic RG. Continuous breath sounds are often caused by mucosal swelling. They sometimes produce viscous secretions in the lungs. If the upper airways are narrowed, it is called stridor. Bronchial asthma and chronic obstructive pulmonary disease (COPD) can cause a high-frequency whistling or wheezing sound. A low-frequency hum occurs when threads of mucus float freely in the large portion of the lungs. Breathing air causes these filaments to vibrate, creating sounds and resulting in a rattling noise.
Diseases with this symptom
- Bronchial asthma
- Bronchiectasis
- Bronchitis
- Pulmonary embolism
- Heart failure
- COPD
- Pneumonia
- Pneumothorax
- Pulmonary emphysema
- Pseudocroup
- Pulmonary edema
- Poisoning
- Aspergillosis
- Dilated cardiomyopathy
- Aspiration
Diagnosis and course
Pulmonary edema associated with large fluid collections can sometimes be heard without a stethoscope. A physician auscultates the affected person’s lungs and quickly identifies whether the rales are continuous or discontinuous. He or she examines the individual for other symptoms to diagnose conditions such as left heart failure, pneumonia, bronchitis, pneumothorax, COPD or bronchial asthma. If it is not an acute emergency situation, he takes a detailed history and may order x-rays.The secretions secreted in the lungs are examined for pathogens or other infectious processes.
Complications
Rales can occur due to various diseases of the lungs, these also carry some complications. For example, bronchial asthma produces the typical sounds. In addition to shortness of breath and fear of suffocation, status asthmaticus is a feared complication. In this asthma attack, antiasthmatics are usually ineffective, which is why this condition requires emergency medical care. There may be a lack of oxygen, causing the body to go into cyanosis. Chronic asthma can also lead to hyperinflation and consequent destruction of the alveoli (emphysema). This increases the blood pressure in the supplying pulmonary vessels and leads to a strain on the right heart, which can end in heart failure (right heart failure). In addition, pulmonary edema can also cause rales. The accumulation of fluid can inflame the lungs (pneumonia), causing shortness of breath and chest pain. In the worst cases, respiratory insufficiency occurs, and the affected person suffers oxygen deprivation. In addition, the inflammation can spread throughout the body, leading to sepsis, which is not infrequently fatal. In some cases, inflammation of the meninges (meningitis) can also occur as a secondary disease, which can lead to an abscess in the brain, but inflammation of the heart or joints can also be considered.
When should you go to the doctor?
Rales in the lungs must be clarified in any case by a medical professional and treated if necessary. Often, rattling breathing sounds indicate a respiratory disease that can take a serious course if left untreated. A visit to the doctor is recommended at the latest when the complaints increase or accompanying symptoms develop. Warning signs of an underlying condition requiring treatment include shortness of breath, dizziness and a blue discoloration of the lips. In the event of severe breathing difficulties of this kind, an emergency physician should be called. If accompanied by sore throat, fever or cough, a doctor can rule out or treat a possible infectious disease. Anyone who suspects an allergic reaction as the cause of the rales should have an allergy test performed. It is also possible that a serious lung disease, such as pulmonary edema, is underlying the symptoms and must be treated immediately. In general, unusual rales that may be associated with accompanying symptoms require specialist treatment. Patients with existing disease should discuss changes in respiratory tone with their treating physician to avoid complications and a severe course.
Treatment and therapy
Rales may be a symptom of a life-threatening situation. This is especially true if they occur suddenly. If there is underlying left heart failure with pulmonary edema formation, the victim’s upper body is elevated. The emergency medical team administers oxygen as well as medication. Left heart failure cannot be cured, but it can be treated with appropriate long-term drug therapy. Therapy may include lifestyle adjustments to accommodate the condition. Pneumothorax can be life-threatening. The first priority in treatment is to expel air from the pleural space so that negative pressure can build up. This is essential for the lungs to re-inflate. The air is expelled by means of a chest drain. The so-called Bülau drain drains fluids. Bacterial pneumonia is usually treated with antibiotics. This is supplemented by measures to relieve symptoms, such as bed rest and sparing. Bronchitis is treated by administering medication. A doctor prescribes either antibiotics, bronchospasmolytics, or medications for the cough, depending on the type of bronchitis. Bronchial asthma is also treated with medication. People affected by COPD rely on permanent breathing support as well as extensive drug treatment. Depending on the severity of the case, the doctor may consider a lung transplant.
Outlook and prognosis
A rales can be caused by many different diseases and other causes. In most cases, however, treatment by a doctor is necessary, and severe complications can occur without treatment.In the worst case, acute shortness of breath or heart failure occurs. Due to the shortness of breath, it is not uncommon for panic attacks to occur. Likewise, an asthma attack can occur. The patient’s everyday life is therefore severely restricted. Physical exertion is no longer possible. If the fluid in the lungs becomes inflamed, this can lead to pneumonia. This generally leads to a lack of oxygen and has a strong negative effect on the entire body. Similarly, inflammation can also occur in the brain or heart. These have serious consequences for the patient. Depending on the cause, treatment is carried out by surgical intervention or with the help of antibiotics. In acute attacks, an emergency physician must be called, who will care for the patient.
Prevention
To keep the lungs healthy and prevent rales, it is recommended that people refrain from smoking. People with a predisposition to bronchial asthma or COPD especially benefit from a healthy lifestyle that includes exercise. Regular exercise increases the volume of the lungs as well as the network of capillaries, allowing more oxygen to be absorbed with each breath.
Here’s what you can do yourself
Rales can be alleviated by a few simple measures and various home remedies. Tea preparations of ginger, spruce, thyme or mullein have proven effective. Severe mucus can be relieved by steam baths or inhalations with eucalyptus, sage or camphor. To stimulate the mucous membranes and thus promote the removal of mucus, sufficient fluids should also be consumed. Accompanying [[Heat therapy|Heat and bed rest. If the rales are due to bronchitis, homeopathic remedies can also be used. Globules such as Bryonia, Echinacea or Aconitum alleviate the symptoms and are especially helpful at the beginning of a cold or bronchitis. Classic home remedies such as garlic or ginger act as natural antibiotics and make it easier for the bronchial tubes to clear excess mucus. Lettuce is also said to have a soothing effect on bronchitis-like symptoms. Gluten should be avoided in the case of rattling breathing noises, as the substance may promote the formation of mucus. The same applies to milk and dairy products as well as irritating foods and dishes. Smoking should be discontinued immediately in the event of respiratory problems. To prevent rales in the long term, it is recommended to strengthen the immune system and respiratory tract by reducing stress, eating a balanced diet and exercising.