Breath Sounds From Basic Science to Clinical Practice

314 Pages·2018·8.861 MB·English

by  Kostas N. Priftis, Leontios J. Hadjileontiadis, Mark L. Everard (eds.)

Breath Sounds
From Basic Science
to Clinical Practice
Kostas N. Priftis
Leontios J. Hadjileontiadis
Mark L. Everard
Editors
123
Breath Sounds
Kostas N. Priftis
Leontios J. Hadjileontiadis • Mark L. Everard
Editors
Breath Sounds
From Basic Science to Clinical Practice
Editors
Kostas N. Priftis Leontios J. Hadjileontiadis
Children’s Respiratory and Allergy Unit Department of Electrical & Computer
Third Department of Paediatrics Engineering
“Attikon” Hospital Aristotle University of Thessaloniki
National and Kapodistrian University Thessaloniki
of Athens Greece
Athens
Greece
Mark L. Everard
Division of Child Health
University of Western Australia
Perth Children’s Hospital
Perth
Australia
ISBN 978-3-319-71823-1 ISBN 978-3-319-71824-8 (eBook)
https://doi.org/10.1007/978-3-319-71824-8
Library of Congress Control Number: 2018938548
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Preface
It is now just over 200 years since René-Théophile-Hyacinthe Laennec invented the
stethoscope and 2018 will be the bicentennial of the publication of his masterpiece,
A treatise on the diseases of the chest and on mediate auscultation. The intervening
centuries have seen the stethoscope becoming a ubiquitous tool that is synonymous,
in the minds of the general public, with the medical profession. Despite repeated
reports of its imminent demise, the stethoscope continues to evolve and contribute
to clinical care throughout the world.
In light of the imminent anniversary of Laennec’s textbook, it seems appropriate
to revisit the role of this inexpensive tool in the assessment of respiratory health and
disease and consider its future in a world in which the conventional stethoscope is,
in a number of settings, being replaced by increasingly sophisticated electronic
devices. This publication is not intended to be a classical ‘textbook’, but rather a
‘state-of-the-art’ review on specific clinical and research topics on the subject of
respiratory sounds. The starting point was the training of the clinician: from the
student to the chest physician. At the same time, the goal was to allow the clinician
to talk to the scientist and get an idea of the cutting edge of relevant technology and
research.
The book is divided in four parts. The first part covers a wide spectrum of general
issues regarding the history of stethoscope, the clinical usefulness, epidemiology
and nomenclature of breath sounds. The second part of the book is mainly devoted
to the science, i.e. sound recording, analysis and perception. The third part deals
with clinical issues regarding adventitious respiratory sounds, laryngeal origin
sounds, sleep and cough sounds. Finally, the fourth part chapters emphasise a view
of the future.
In order to provide the most comprehensive picture of the past, present and future
evolution of the stethoscope, from the original roll of parchment to its highly sophis-
ticated electronic descendants that connect to the Internet and provide computerised
analysis, experts from a range of backgrounds were invited to share their knowl-
edge. We are grateful to all the authors for their effort, time and efficiency in this
common endeavour.
v
vi Preface
We are indebted to the publisher, Springer International Publishing AG, for
adopting and supporting this project. Special thanks and gratitude go to Donatella
Rizza for her expert advice and editorial organisation. We are also grateful to
Barbara Pittaluga and Rekha Udaiyar for their patience and help.
Athens, Greece Kostas N. Priftis
Thessaloniki, Greece Leontios J. Hadjileontiadis
Perth, Australia Mark L. Everard
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Andrew Bush
Part I General Consideration
2 The Stethoscope: Historical Considerations . . . . . . . . . . . . . . . . . . . . . . 15
Robert Lethbridge and Mark L. Everard
3 Clinical Usefulness of Breath Sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Sotirios Fouzas, Michael B. Anthracopoulos,
and Abraham Bohadana
4 Breath Sounds in Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Patricias W. Garcia-Marcos, M. Innes Asher, Philippa Ellwood,
and Luis Garcia-Marcos
5 Nomenclature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Hasse Melbye
Part II Sound Recording, Analysis and Perception
6 Physics and Applications for Tracheal Sound
Recordings in Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Thomas Penzel and AbdelKebir Sabil
7 Sound Transmission Through the Human Body . . . . . . . . . . . . . . . . . 105
Steve S. Kraman
8 Breath Sound Recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Yasemin P. Kahya
9 Current Techniques for Breath Sound Analysis . . . . . . . . . . . . . . . . . . 139
Leontios J. Hadjileontiadis and Zahra M. K. Moussavi
vii
viii Contents
Part III Respiratory Sounds
10 Normal Versus Adventitious Respiratory Sounds . . . . . . . . . . . . . . . . 181
Alda Marques and Ana Oliveira
11 Wheezing as a Respiratory Sound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Grigorios Chatziparasidis, Kostas N. Priftis, and Andrew Bush
12 Crackles and Other Lung Sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Konstantinos Douros, Vasilis Grammeniatis, and Ioanna Loukou
13 Respiratory Sounds: Laryngeal Origin Sounds . . . . . . . . . . . . . . . . . . 237
Nicola Barker and Heather Elphick
14 Sleep Evaluation Using Audio Signal Processing . . . . . . . . . . . . . . . . . 249
Yaniv Zigel, Ariel Tarasiuk, and Eliran Dafna
15 Cough Sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Saikiran Gopalakaje, Tony Sahama, and Anne B. Chang
Part IV Where Are We Going?
16 Future Prospects for Respiratory Sound Research . . . . . . . . . . . . . . . 291
Alda Marques and Cristina Jácome
17 In Pursuit of a Unified Nomenclature of Respiratory Sounds . . . . . . 305
Kostas N. Priftis, Maria Antoniadi, and Hans Pasterkamp
18 Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Mark L. Everard, Kostas N. Priftis, and Leontios J. Hadjileontiadis
Introduction 1
Andrew Bush
A long time ago in a galaxy far, far away, I started in the University College Hospital
London medical school and purchased my first stethoscope, which consisted of a
bell and a diaphragm joined by a rubber tube to two earpieces. At that time, tele-
phone calls were made on Bakelite telephones with a circular dial, and one inserted
a finger into the appropriate hole and rotated it; urgent communications were by
telegram at a given cost per word; and lecturers used glass-mounted slides or drew
on the blackboard to illustrate their talks. After nearly 40 years as a doctor, and more
than a quarter of a century of consultant practice, smartphones are replete with
unbelievable quantities of APPs, computing and storage power; the telegram is as
dead as the dinosaurs, and instead social media such as Facebook, Instagram,
Snapchat and Twitter rule; and PowerPoint reigns supreme in the conference and
lecture room. And lo! My stethoscope still consists of a bell and a diaphragm joined
by a rubber tube to two earpieces. It is difficult to believe that this medical stagna-
tion in the face of so much technological transformation elsewhere reflects much
credit on anyone. So where are we, and where are we going: and the main purpose
of this book is to review exactly this. This introduction is intended to set the scene
by being a provocative look at past, present and future chest auscultation, in order
to stimulate thought (and possibly rage!) in the interested reader.
AB is an NIHR Senior Investigator and additionally was supported by the NIHR Respiratory
Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust
and Imperial College London.
A. Bush, MD, FRCP, FRCPCH, FERS, FAPSR
National Heart and Lung Institute, London, UK
Imperial College, London, UK
Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
Royal Brompton Harefield NHS Foundation Trust, London, UK
e-mail: [email protected]; [email protected]
© Springer International Publishing AG, part of Springer Nature 2018 1
K. N. Priftis et al. (eds.), Breath Sounds, https://doi.org/10.1007/978-3-319-71824-8_1
2 A. Bush
1.1 The Thoracic Cage as Checkpoint Charlie: The Good,
the Bad and the Totally Unintelligent
An important evolutionary task is to protect the organism from external assaults
such as heat, cold and a well-directed spear by encasing it in protection either natu-
ral (e.g. bones, a thick hide, scales or a shell) or artificially manufactured armour.
The thoracic cage gives good protection to the heart and lungs, but this natural
protective layer has the undesirable effect of muffling or eliminating many signals
of disease from within the organism, the discernment of which may allow a benefi-
cial intervention. This was of small concern when there were no such interventions,
and all the physician had to offer amounted to little more than tea and sympathy. In
the twenty-first century, the field has changed:
• We have ever more powerful diagnostic tests which completely bypass the pro-
tective layers, such as HRCT, MRI and other imaging modalities, to say nothing
of sophisticated biological tests including genetics, ciliary function and increas-
ingly likely -omics technology.
• There are increasingly precise therapeutics, such as the designer molecules for
gene class-specific mutations in cystic fibrosis [1, 2] and an increasingly formi-
dable array of monoclonals for asthma [3, 4].
• We are moving further away from asking ‘are you feeling better’ to the use of
specific biomarkers and molecular tests for diagnosis [5] and to monitor disease
progression [6].
• Non-invasive testing in preschool infants and even babies is increasingly moving
out of the research field and into the routine clinical arena [7]. So, for example,
sputum induction for the diagnosis of tuberculosis is being performed in primary
health-care centres in South African townships [8], and multiple breath washouts
are feasible in clinical settings [9, 10].
So has the time come for the clinician to be pensioned off in favour of a more
cheerful version of Douglas Adams’s Marvin the severely depressed and bored
robot with a brain the size of a planet (The Hitchhikers Guide to the Galaxy)?
Paradoxically, the greater technological advances mean that clinical skills become
more, not less, important. So not every child with a runny nose can or should have
nasal nitric oxide, assessment of ciliary beat frequency and pattern, ciliary electron
microscopy and electron microscopic tomography, whole exome sequencing, cili-
ary immunofluorescence and finally ciliary culture lest a diagnosis of primary cili-
ary dyskinesia is missed [11, 12]. The clinical skill that is absolutely essential is to
pick out the handful of such children in whom this diagnosis should be pursued at
all hazard [13–16]. To do this, old-fashioned skills of history and physical examina-
tion must be deployed but with two important caveats: firstly, we must not be com-
placent but accept that these can and should be honed, and secondly, we need to
recognise when the patient’s journey has reached the point when clinical skills are
no longer useful.