Rattling in chest when breathing
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Summary
6 papers analyzed
These studies suggest that rattling in the chest when breathing can be caused by various factors such as airway obstruction, respiratory conditions, or terminal illness, and may be described as wheezing, crackles, or other adventitious sounds.
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Understanding Rattling in the Chest When Breathing
Rattling in the chest when breathing can be a distressing symptom, often indicative of underlying respiratory conditions. This article synthesizes current research to provide a comprehensive understanding of the causes, diagnosis, and management of this symptom.
Causes of Chest Rattling: Respiratory Secretions and Airway Obstruction
Rattling sounds in the chest, also known as rales or rhonchi, are often caused by the presence of secretions in the airways or by airway obstruction. These sounds can be heard during auscultation with a stethoscope and are classified into different types based on their characteristics. In children, wheezing and rattling can result from airway obstruction due to tissues, secretions, or foreign substances, which can be audible without the need for auscultation.
Diagnostic Approaches: Auscultation and Imaging
Auscultation remains a critical diagnostic tool for identifying the nature of chest sounds. The differentiation between normal breath sounds and adventitious sounds such as crackles, wheezes, and rhonchi is essential for accurate diagnosis. In cases where recurrent wheezing and chest rattling are present, further diagnostic imaging such as chest radiographs and computed tomography (CT) scans may be necessary. For instance, in a case study of an 8-year-old girl with recurrent wheezing and chest rattling, imaging revealed a vascular ring causing airway compression, which was successfully treated surgically.
Rattling in Terminal Patients: The Death Rattle
In terminally ill patients, particularly those with pulmonary malignancies or neurological conditions, a phenomenon known as the "death rattle" can occur. This is caused by oscillatory movements of secretions in the oropharynx, hypopharynx, and trachea during inspiration and expiration. The death rattle is a common occurrence in the final hours of life and is often distressing for both patients and their families .
Management Strategies: Pharmacological Interventions
Management of chest rattling, especially in terminal patients, often involves pharmacological interventions to reduce respiratory secretions. Antimuscarinic medications such as atropine and hyoscine hydrobromide have been used to manage the death rattle. However, studies have shown that atropine may not be significantly more effective than a placebo in reducing the noise associated with respiratory tract secretions. Despite this, injectable scopolamine remains a reference drug for symptomatic treatment, providing relief to relatives and caregivers.
Conclusion
Rattling in the chest when breathing can arise from various causes, including airway obstruction and respiratory secretions. Accurate diagnosis through auscultation and imaging is crucial for effective management. In terminal patients, managing the death rattle with appropriate medications can alleviate distress for both patients and their families. Understanding these aspects can help in providing better care and improving the quality of life for individuals experiencing this symptom.
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