Lung sound nomenclature survey.

We report the terms used by 223 pulmonary physicians and 54 physicians in other specialties to describe eight recorded examples of lung sounds. The participants listened to the lung sounds at the 1988 American College of Chest Physicians annual convention and wrote "free form" answers. Pulmonary physicians used the terms "crackles" and "rales" with equal frequency to describe discontinuous adventitious lung sounds (ALS) and not at all to describe continuous ALS. Other physicians preferred the term "rales" in describing discontinuous ALS. The terms "wheeze" and "stridor" were used only in describing continuous ALS; however, the term "rhonchi" was frequently used to describe continuous and discontinuous ALS. The majority of participants recognized the normal breath sounds but not the pleural friction rub. Most did not use a qualifying adjective to describe ALS, and there was little agreement among those who did. The lung sound terminology used by physicians is not well standardized and the recommendations of the ATS/ACCP nomenclature subcommittee are not widely accepted.

Comparing RCPs to physicians for the description of lung sounds: are we accurate and can we communicate?

UNLABELLED: Precise communication among clinicians of chest-auscultation findings depends on use of standardized nomenclature for lung sounds. To identify the current practice of clinicans in describing lung sounds, we surveyed physicians and respiratory care practitioners (RCPs). MATERIALS AND METHOD: Surveys were specifically designed to identify: (1) whether RCPs and physicians use similar terms to describe adventitious lung sounds (ALS), (2) whether changes are occurring in response to the recommendations of the ATS-ACCP Ad Hoc Subcommittee on Pulmonary Nomenclature, and (3) whether RCPs and physicians differ in their ability to accurately recognize ALS. We surveyed 156 RCPs at the 1987 Annual Meeting of the American Association for Respiratory Care and 223 pulmonary physicians (PPs) and 54 nonpulmonary physicians (NPPs) at the 1988 Annual Meeting of the American College of Chest Physicians. Each survey participant was required to listen to five examples of ALS using earphones and an audiocassette player and then to write 'free-form' descriptions of what they heard. (All participants listened to the same ALS.) RESULTS: Fine crackles and high-pitched monophonic and polyphonic wheezes were readily recognized by the majority of RCPs and physicians. Fine crackles were described as rales or crackles; high-pitched, monophonic wheezes were described as stridor or wheezes; however, high-pitched, polyphonic wheezes were usually described as wheezes. RCPs and physicians used a variety of terms to describe coarse crackles and rhonchi. The term rhonchi was frequently used inappropriately by all groups surveyed. There were no significant differences between PPs and RCPs in their ability to accurately recognize adventitious lung sounds; however, PPs were superior to NPPs (p less than 0.05) in this regard. PPs were superior to RCPs and NPPs (p less than 0.05) in appropriately using the term 'fine' for the description of crackles. CONCLUSION: All three groups of clinicians need to improve their ability to recognize and describe lung sounds.

Survey of adventitious lung sound terminology in case reports.

Descriptions of adventitious lung sounds in the case reports of eight authoritative medical journals from 1978 through 1982 were tabulated in an effort to identify recent changes in terminology. Adventitious lung sounds were described in 590 case reports. During the five years surveyed, there was a decrease in usage of the term, "rales," and an increase in usage of the terms, "crackles" and "wheezes." Usage of the terms, "rhonchi" and "crepitations," did not significantly change in frequency over the five years surveyed; however, when compared to a previous survey, usage of the term, "crepitations," has declined. British journals predominantly use the terms, "crackles" and "wheezes," to describe adventitious lung sounds. Although American journals most often use the terms, "rales," "wheezes," and "rhonchi," the term, "crackles," is increasing in usage.