Intravenous sildenafil for treatment of early pulmonary hypertension in preterm infants
How Tiny Valves Can Improve Your Respiratory Health
For nearly 18 million Americans, living with chronic obstructive pulmonary disease (COPD) is a difficult reality. The progressive disease limits air flow to the lungs and causes breathing problems. Emphysema, a type of COPD, destroys the air sacs that expand and contract when breathing.
As emphysema destroys tissue, the lung enlarges, preventing proper inhalation and exhalation, trapping air in the lungs. Consequently, the lungs expand and become overinflated, making it even more difficult to breathe.
"With emphysema changes, there is no room for a patient to take a deep breath," explains Dr. Abdul Alraiyes, an interventional pulmonologist at Advocate Health Care. "Treatment of COPD and emphysema, which are both incurable, has typically included measures such as lifestyle changes, rescue inhalers and oxygen therapy."
Now, a new minimally invasive lung procedure is improving lung function and enhancing breathing efficiency. Known as a bronchoscopic lung volume reduction (BLVR), the technique involves inserting tiny valves into the lung. The valves open upon exhalation, helping trapped air exit the body.
A bronchoscope is used to place the valves, which deflate the damaged part of the lung and gradually restore a more normal lung volume. "Over time, the goal is to deflate the bad part of the lung," says Dr. Alraiyes. "This allows patients to have greater lung reserve volume and take deep breaths."
Post procedure, individuals experience relief from their lung disease symptoms and a serious improvement in lung function.
"This advanced procedure plays a pivotal role in enhancing the quality of life for patients suffering from severe respiratory limitations," says Dr. Alraiyes.
Want to learn more about your risk for lung cancer? Take a free online quiz.
Lung Sounds: What Do They Mean?
When you go for a sick visit or your annual checkup at your doctor's office, they will likely listen to your chest through a stethoscope. Part of what they're listening for is the sounds your lungs make as you breathe in and out. Listening to your lung sounds gives your doctor a clue about how well your lungs are working.
Your doctor will use a stethoscope to listen to your lung sounds. The medical term for this is auscultation. (Photo Credit: DigitalVision/Getty Images)
There are three types of normal lung sounds that are different depending on where in your chest your doctor is listening. The three normal lung sounds are bronchial, bronchovesicular, and vesicular.
Bronchial lung sounds
Your doctor can hear these most clearly when you breathe out. They'll listen high in your chest and over your windpipe for loud, rough, and high-pitched lung sounds. These sounds are normal in your bronchial area, but may be abnormal in other areas of your lungs.
Bronchovesicular lung sounds
Your doctor can hear these sounds when you breathe in and out. They'll listen in the middle part of your chest for sounds are lower-pitched than bronchial lung sounds but higher-pitched than vesicular lung sounds.
Vesicular lung sounds
Your doctor can hear these sounds best when you breathe in. They'll listen in your mid-back for soft, smooth, low-pitched sounds. These tell your doctor that nothing (like mucus) is blocking your airways, and there's no swelling or narrowing that's stopping you from taking a full breath.
Adventitious lung sounds
Adventitious sounds are ones that your doctor hears in addition to the normal sounds. These noises can help your doctor identify problems in your lungs. For instance, lung conditions like bronchitis or pneumonia can cause adventitious lung sounds. The five most common abnormal lung sounds are:
Read on to learn more about these common types of adventitious lung sounds and a few less common ones.
A wheeze (or sibilant rhonchus) is a continuous, high-pitched lung sound. Wheezing may be easier to hear when you breathe out, but sometimes you can hear it when you're breathing in and out. You may even be able to hear wheezing without a stethoscope. Wheezing indicates you have a narrowed airway that limits the flow of air in and out of your lungs.
Wheezing causes
The most common causes of wheezing include:
You can also start wheezing if you smoke or as a side effect of some medications (such as aspirin if you have asthma).
Rales, or crackles, are discontinuous, interrupted, or explosive lung sounds. They may sound like pulling velcro open. The sounds can be short and high-pitched, or they may last a bit longer and be lower-pitched. Your doctor is more likely to hear crackles when you're breathing in, but they may happen when you breathe out, too. Rales happen when your airway snaps open as you breathe in.
Rales causes
Common causes of short, high-pitched rales (fine crackles) include:
Longer, low-pitched rales (coarse crackles) are caused by the same conditions as fine crackles but suggest a more advanced state of the condition.
Stridor is a continuous, rough, high-pitched whistle or squeaking lung sound. Your doctor is more likely to hear it when you breathe in. Like wheezing, stridor suggests you have blocked airflow, but it happens more in your upper airway or throat than in your chest.
Stridor causes
Causes of stridor include:
Rhonchi (also called sonorous rhonchi) are loud, continuous, low-pitched, snoring, or gurgling lung sounds. Your doctor may be able to hear them best when you're breathing out, but they may also hear them when you breathe in and out. The sound might move around to different parts of your chest when you cough as mucus moves around. These sounds happen because your larger airways are narrowed by mucus, and they flutter as air flows through.
Rhonchi causes
Wheezing and rhonchi have a similar cause (narrowed airways usually due to fluid buildup), so the causes are mostly the same. For instance, rhonchi is often caused by:
Pleural rub is a rough, scratching, or grating lung sound. Your doctor will hear it when you breathe in and out. It's usually louder than other lung sounds since it's happening in your chest wall. You get pleural rub when the linings of your lungs (pleura) swell and rub against each other.
Pleural friction rub causes
Possible causes of pleural rub include:
Whooping is a loud, high-pitched gasp lung sound. You may make this noise when you gasp for air after a coughing fit. You will be able to hear this when you breathe in as you fill your lungs after expelling all your air when coughing.
Whooping causes
The most common cause of whooping lung sounds is an infection with a bacteria called Bordetella pertussis, commonly called whooping cough.
Hamman's sign is a crunchy or scratchy lung sound that happens in time with your heartbeat. This sound indicates that you have air trapped in the space between your lungs (a medical condition called pneumomediastinum). The sound is caused by shifting of the trapped air from the movement of your heart as it beats.
Hamman's sign causes
The most common causes of pneumomediastinum include:
Infants with breathing problems may make persistent noises, such as:
Your doctor can get important information about the health of your lungs by listening closely as you breathe. The easiest and most common way to do this is to hold a stethoscope to the skin on your back and chest. This is called auscultation.
As your doctor listens, they'll ask you to take deep breaths through your mouth. They also may ask you to speak certain phrases and see how they sound through your chest or back. Some examples of this include:
Bronchophony
Your doctor will ask you to say "ninety-nine." Normally, your lungs will muffle the words. If the words sound clear through the stethoscope, it may be a sign that your lungs are filled with blood, fluid, or mucus.
Whispered pectoriloquy
This involves whispering "ninety-nine" or "one, two, three." Healthy lungs will dampen the sound and make the words faint, but they'll be louder if your lungs are filled with fluid.
Egophony
If you have fluid in your lungs, your doctor uses this test to check for a collapsed lung. As you say an "e" sound, your doctor will listen to see if it's muffled and sounds like "e" or if it's louder and sounds like "a," which means fluid is changing the sound.
If you notice you have abnormal or changes in your breathing sounds, you should go get checked out by your doctor.
And if you have any of the following symptoms, call 911 and get to the ER right away:
As part of your physical exam, your doctor will listen to your lung sounds through a stethoscope. Part of what they are listening for is adventitious lung sounds, which are sounds your lungs make in addition to your normal breathing sounds. The five major adventitious lung sounds are wheezing, rales, stridor, rhonchi, and pleural rub. Various conditions cause different sounds, although there can be overlap. Lung sounds are one clue your doctor uses to help them figure out what is causing you to have breathing problems.
What lung sounds does pneumonia have?
This depends on whether you have viral or bacterial pneumonia. Bacterial pneumonia tends to be more severe than viral pneumonia. People with bacterial pneumonia can have wheezing, rales, rhonchi, and pleural rub. People with viral pneumonia may only have a dry cough.
What do congested lungs sound like?
Congestion in your lungs is usually due to mucus or swelling. If you have congestion, you may have wheezing, rales, rhonchi, and pleural rub.
VA Disputes Claim That Removing Race From Lung Tests Would Greatly Alter Disability Payments
Veterans Affairs department officials said Monday they have launched a study to determine how removing race from widely used lung function tests may affect disability benefits for veterans, and they expect the impact to be much smaller than predicted in a study published earlier this year.
They also said veterans who may have heard about the issue should not be concerned about any sudden changes to their benefits. Any changes, said Olumayowa Famakinwa, who oversees implementation of the VA's rating schedule for disabilities, would come with ample notification and the ability for veterans to appeal.
"If I was talking to a veteran, I'd say, give us some time, but we'll figure it out for sure and you can remain confident you will get the benefits you've earned," he said.
In 2023, in response to outcries that using race in pulmonary function tests can underestimate the extent of disease in Black patients, and to a smaller extent in Asian patients, the American Thoracic Society released new guidelines stating that the use of race was contributing to health disparities and should be ended. A race-based equation had long been used to guide interpretations of results from spirometry tests and over time were built into the software of the machines.
The tests are used to help diagnose lung disease and guide treatment decisions, as well as in determining disability payments.
A study published in May in the New England Journal of Medicine analyzed how a race-free equation might affect patients. Using data from a large population study, the authors estimated that the change could affect more than 400,000 veterans and lead to redistribution of nearly $2 billion dollars, with 17% more overall going to Black veterans and just over 1% less going to white veterans.
In an interview with STAT, veterans officials said they thought the study had vastly overestimated the number of veterans who were entitled to benefits and the amount that benefits might change for individuals, because the researchers did not use VA numbers but extrapolations from population-wide data.
"As far as I can tell, there was no VA engagement in that manuscript," said David Au, a pulmonologist who directs the Veterans Health Administration's Center for Care and Payment Innovation. "We would have been happy to help contribute."
Au said he appreciated the attention the study had brought to the issue, but hoped the study could be corrected or revised or that the authors would work with the VA in the future to create more precise estimates.
The study's lead author, Arjun Manrai, an assistant professor of biomedical informatics at Harvard, said he appreciated the VA's comments and agreed the populations were not as precise as they would have been had the authors used VA data directly.
But he said he believed the larger finding, that Black veterans might be due additional benefits if pulmonary function tests, or PFTs, employed race-free equations, was not likely to change. "Ultimately, we are confident in our estimates of the direction and magnitude of changes expected with widespread adoption of race-neutral PFTs," he told STAT, adding that he would like to see the VA's data.
VA officials said potential changes to disability payments were not likely to be as large as the study estimated for a number of reasons. First, pulmonary function tests are only one factor in determining lung disability. A wide range of tests and other factors, such as whether people need bronchodilators to control asthma or have been prescribed outpatient oxygen, are also used.
Furthermore, Famakinwa said, most disability claims include a number of service-related disabilities, so altering the amount of lung disability among myriad other claims might reduce or increase a disability award very little or not at all.
The VA began studying the issue after the ATS recommendation was released and it hopes to determine a new policy by September 2025, said Au, who added he was fully on board with the larger issue of removing race from clinical algorithms but said removing them in pulmonology was not straightforward. "This is really an implementation problem," Au said. "It's messy and it's complex."
He said VA officials do not want to make a change that may introduce a new health disparity. "Ten years ago, 15 years ago, there were disparities in care delivery in the VA. The most recent data has shown we've eliminated most disparities in terms of treatment and outcome [for lung cancer] between Black and white veterans," he said. "What we were concerned about is if we implemented this wholesale, would we induce new disparities."
As an example, he cited a JAMA Surgery paper published last year that showed Black patients might be less likely to receive a more aggressive and more effective lung cancer surgical option if their lung function was assessed using race-neutral equations. "That was alarming to us," Au said.
Another issue is that if relatively simple PFT tests are replaced by more complex tests that are not offered at every VA hospital, it could create access barriers for veterans with transportation issues or other complications. "Every time you add a layer of complexity to testing, you drop out a population," Au said.
Au said decisions about how to administer the tests were up to individual VA centers, and 30% had begun to use the race-free equation, while the rest had not, causing some problems for continuity of care. The VA has paused roll out of the changes for the time being, he said. "We really want [changes] to be consistent and equitable across the system," he said.
The VA moved more quickly to implement race-free tests for kidney function, but Au said that was a simpler decision because nephrologists had a gold-standard test in that case and data modeling showed a race-free equation had a similar performance. Pulmonary function tests, he said, have no gold standard or new data analyses and are affected by a wide variety of factors including ancestry, poverty, and air pollution, making the issue far less clear. "I wish we were nephrologists," he said.
The story has been updated to clarify that David Au meant to say the VA had curbed disparities in lung cancer, not in all areas of medicine.
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