The nomenclature committee recommended the terms "fine" and "coarse" be used to qualify crackles following the suggestion by Forgacs that adjectives with a physiologic or acoustic basis (eg, low-pitched, high-pitched, fine, coarse) be used rather than the traditional terms (eg, dry, wet, sonorous, sibilant, etc). In addition to the basic terms used to describe ALS, qualifying adjectives may improve or confuse communication. The committee most recently suggested that discontinuous adventitious lung sounds be described as "crackles," high-pitched continuous ALS be described as "wheezes," and low-pitched continuous ALS be described as "rhonchi." The term "rales" was considered undesirable because it had historically been used to describe both continuous and discontinuous ALS. An Ad Hoc Subcommittee on Pulmonary Nomenclature established by the American College of Chest Physicians and the American Thoracic Society has made recommendations in an attempt to achieve this goal. The clinical value of chest auscultation would be enhanced by the use of a consistent nomenclature for lung sounds. The lung sound terminology used by physicians is not well standardized and the recommendations of the ATS/ACCP nomenclature subcommittee are not widely accepted.ĪLS = adventitious lung sounds RCP = respiratory care practitioner PP = pulmonary physicians NPP = nonpulmonary physicians Most did not use a qualifying adjective to describe ALS, and there was little agreement among those who did. The majority of participants recognized the normal breath sounds but not the pleural friction rub. The terms "wheeze" and "stridor" were used only in describing continuous ALS however, the term "rhonchi" was frequently used to describe continuous and discontinuous ALS. Other physicians preferred the term "rales" in describing discontinuous ALS. Pulmonary physicians used the terms "crackles" and "rales" with equal frequency to describe discontinuous adventitious lung sounds (ALS) and not at all to describe continuous ALS. The participants listened to the lung sounds at the 1988 American College of Chest Physicians annual convention and wrote "free form" answers. We report the terms used by 223 pulmonary physicians and 54 physicians in other specialties to describe eight recorded examples of lung sounds.
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