Abstract
BackgroundWheezes and crackles are well-known signs of lung diseases, but can also be heard in apparently healthy adults. However, their prevalence in a general population has been sparsely described. The objective of this study was to determine the prevalence of wheezes and crackles in a large general adult population and explore associations with self-reported disease, smoking status and lung function.MethodsWe recorded lung sounds in 4033 individuals 40 years or older and collected information on self-reported disease. Pulse oximetry and spirometry were carried out. We estimated age-standardized prevalence of wheezes and crackles and associations between wheezes and crackles and variables of interest were analyzed with univariable and multivariable logistic regressions.ResultsTwenty-eight percent of individuals had wheezes or crackles. The age-standardized prevalence of wheezes was 18.6% in women and 15.3% in men, and of crackles, 10.8 and 9.4%, respectively. Wheezes were mostly found during expiration and crackles during inspiration. Significant predictors of expiratory wheezes in multivariable analyses were age (10 years increase - OR 1.18, 95%CI 1.09–1.30), female gender (1.45, 1.2–1.8), self-reported asthma (1.36, 1.00–1.83), and current smoking (1.70, 1.28–2.23). The most important predictors of inspiratory crackles were age (1.76, 1.57–1.99), current smoking, (1.94, 1.40–2.69), mMRC ≥2 (1.79, 1.18–2.65), SpO2 (0.88, 0.81–0.96), and FEV1 Z-score (0.86, 0.77–0.95).ConclusionsNearly over a quarter of adults present adventitious lung sounds on auscultation. Age was the most important predictor of adventitious sounds, particularly crackles. The adventitious sounds were also associated with self-reported disease, current smoking and measures of lung function. The presence of findings in two or more auscultation sites was associated with a higher risk of decreased lung function than solitary findings.
Highlights
Wheezes and crackles are well-known signs of lung diseases, but can be heard in apparently healthy adults
Adventitious lung sounds (ALS) such as wheezes and crackles are associated with common diseases like asthma [3], chronic obstructive pulmonary disease (COPD) [4, 5], interstitial lung disease [6], bronchiectasis [7], heart failure [8] and pneumonia [9,10,11]
The continuous variables were dichotomized with cutoff values for age ≥ 65 years, for oxygen saturation ≤ 95% [29], modified Medical Research Council questionnaire (mMRC) score ≥ 2 [30], Body Mass Index (BMI) ≥30 and Forced Expiratory Volume in 1 s (FEV1) below the lower limit of normal (LLN), according to the Global Lung Initiative reference [26]
Summary
Wheezes and crackles are well-known signs of lung diseases, but can be heard in apparently healthy adults. Their prevalence in a general population has been sparsely described. The objective of this study was to determine the prevalence of wheezes and crackles in a large general adult population and explore associations with self-reported disease, smoking status and lung function. There are some obvious advantages of lung auscultation, such as availability, low cost and non-invasiveness. Lung auscultation remains an important part of the respiratory examination, mainly in primary care and in resource-constrained settings. Lung auscultation has shown to be useful in diagnosing various respiratory disorders. Positive findings during auscultation influence clinical decisions such as the rate of antibiotic prescriptions [12, 13] and referrals to specialist care [14]
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