Measurement and theory of wheezing breath sounds

Abstract

We measured the time and frequency domain characteristics of breath sounds in seven asthmatic and three nonasthmatic wheezing patients. The power spectra of the wheezes were evaluated for frequency, amplitude, and timing of peaks of power and for the presence of an exponential decay of power with increasing frequency. Such decay is typical of normal vesicular breath sounds. Two patients who had the most severe asthma had no exponential decay pattern in their spectra. Other asthmatic patients had exponential patterns in some of their analyzed sound segments, with a range of slopes of the log power vs. log frequency curves from 5.7 to 17.3 dB/oct (normal range, 9.8–15.7 dB/oct). The nonasthmatic wheezing patients had normal exponential patterns in most of their analyzed sound segments. All patients had sharp peaks of power in many of the spectra of their expiratory and inspiratory lung sounds. The frequency range of the spectral peaks was 80–1,600 Hz, with some presenting constant frequency peaks throughout numerous inspiratory or expiratory sound segments recorded from one or more pickup locations. We compared the spectral shape, mode of appearance, and frequency range of wheezes with specific predictions of five theories of wheeze production: 1) turbulence-induced wall resonator, 2) turbulence-induced Helmholtz resonator, 3) acoustically stimulated vortex sound (whistle), 4) vortex-induced wall resonator, and 5) fluid dynamic flutter. We conclude that the predictions by 4 and 5 match the experimental observations better than the previously suggested mechanisms. Alterations in the exponential pattern are discussed in view of the mechanisms proposed as underlying the generation and transmission of normal lung sounds. The observed changes may reflect modified sound production in the airways or alterations in their attenuation when transmitted to the chest wall through the hyperinflated lung.