Variety of verbal and amplitude-frequency characteristics of wheezing in patients with bronchial asthma, depending on the severity of bronchial obstruction and shortness of breath

Objective. To study the “language” of whistling wheezing in patients with asthma, the relationship between verbal and amplitude-frequency characteristics (AFC) of wheezing and the severity of bronchial obstruction and dyspnea.

Methods. 72 patients with partially controlled asthma were examined. The patients described whistling breathing by comparison and evaluated the degree of intensity of wheezing and dyspnea (Borg CR-10 scale). Spirometry was carried out with Vitalograph ALPHA spirometer (England) according to the rules of ATS/ERS with a bronchodilator test and simultaneous recording of pulmonary sounds with the Littmann 3,200 electronic stethoscope.

Results. 2 groups of patients were formed based on verbal characteristics of the whistling wheezing. The 1^st group (38 patients) had wheezes of high-tone AFC (576 ± 33 Hz), 6.5 ± 0.7 points of wheezing intensity, and the degree of dyspnea intensity 4.8 ± 1.2 points on the Borg scale. The 2^nd group (34 patients) had wheezes of medium and low-tone AFC (368 ± 40.2 Hz), 3.8 ± 0.6 points of wheezing intensity, and degree of dyspnea intensity 3.7 ± 0.5 points according to Borg scale. Various “language” characteristics of whistling wheezing are obtained. The direct correlation between the degree of obstruction and subjective sensations of whistling breathing was found. The 1^st group had marked moderate and severe bronchial obstruction (FEV1 < 50%). The 2^nd group had mild and medium degree bronchial obstruction (50 > FEV1 < 80%). A positive bronchodilatator test was recorded in 100% patients in the 1^st group and 37% patients in the 2nd group. Postbronchodilator AFC of the wheezes were comparable between the groups. The decrease in the intensity of wheezing led to a reduced severity of shortness of breath. Dyspnea did not affect the subjective intensity of wheezing.

Conclusion. Verbal characteristics of whistling breathing in asthma patients are given. There was a direct strong correlation between the perception of wheezing with the severity of bronchial obstruction and a weak feedback between the intensity of perception of wheezing and shortness of breath before the use of bronchodilator. A direct moderate correlation was found after the bronchodilatator test. The severity of bronchial obstruction in patients with asthma plays a major role in the occurrence of wheezing high-tone AFC. A good response to beta2-agonist inhalation therapy should be expected in these patients.

1. Pasterkamp H., Kraman S.S., Wodicka G.R. Respiratory sounds. Advances beyond the stethoscope. Am. J. Respir. Crit. Care Med. 1997; 156 (3, Pt 1): 974-987. DOI: 10.1164/ajrccm.156.3.9701115.

2. Andres E., Gass R., Brandt C., Hentzler A. Respiratory Sounds Analysis in the World of Health 2.0 and Medicine 2.0. ECPulmonol. Respir. Med. 2018; 7 (8): 564-585.

3. Sarkar M., Madabhavi I., Niranjan N., Dogra M. Auscultation of the respiratory system. Ann. Thorac. Med. 2015; 10 (3): 158-168. DOI: 10.4103/1817-1737.160831.

4. Sovijarvi A.R., Malmberg L.P., Charbonneau G. Vander-schoot J. Characteristics of breath sounds and adventitious respiratory sounds. Eur. Respir. Rev. 2000; 10 (77): 591-596.

5. Gavriely N., Palti Y., Alroy G., Grotberg J.B. Measurement and theory of wheezing breath sound. J. Appl. Physiol. Respir. Environ. Exerc. Physiol. 1984; 57 (2): 481-492. DOI: 10.1152/jappl.1984.57.2.481.

6. Abrosimov V.N. [Bronchial asthma, wheezing, flutter - possible interactions (discussion)]. In: Abrosimov V.N., ed. [Dyspnea and associated syndromes: Interregional collection of scientific papers]. Ryazan; 2014: 38-42 (in Russian).

7. Petrov Ju.V., Glotov S.I., Abrosimov V.N. [First experience of electronic intrapulmonary auscultation in patients with COPD and bronchial asthma]. Nauka molodyh (Eruditio Juvenium). 2015; (4): 45-49 (in Russian).

8. Rogachikov A.I., Urjas'ev O.M. [Technique of inhalation medicines and the control over bronchial asthma]. Rossijskiy mediko-biologicheskiy vestnik im. akad. I.P.Pavlova. 2016; 24 (3): 86-91. DOI: 10.17816/PAVLOVJ2016386-91 (in Russian).

9. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Updated 2019. Available at: https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf [Accessed: June 25, 2019].

10. Gurung A., Scrafford C.G., Tielsch J.M. et al. Computerized lung sound analysis as diagnostic aid for the detection of abnormal lung sounds: a systematic review and metaanalysis. Respir. Med. 2011; 105 (9): 1396-1403. DOI: 10.1016/j.rmed.2011.05.007.

11. Abrosimov V.N. [Visual analogue of shortness of breath, the possibility of practical application]. Terapevticheskiy arhiv. 1989; 61 (3): 126-127. DOI: 10.1016/j.rmed.2011.05.007 (in Russian).

12. Borg G. Simple rating methods for estimation of perceived exertion. Wenner-Gren Center International Symposium Series. 1976; 28: 39-47.

13. Abrosimov V.N. [Pulmonary clearance, respiratory technique and kinesitherapy in patients with chronic obstructive pulmonary disease]. Ryazan: RyazGMU; 2010 (in Russian).

14. Chuchalin A.G. [Shortness of Breath: pathophysiological and clinical aspects]. Terapevticheskiy arhiv. 2005; 77 (3): 5-14 (in Russian).