Lung Sounds Assessment

OT Dude Academy’s Free NBCOT® Exam Prep Course Pulmonology Lung Sounds Assessment

While occupational therapists do not directly assess lung sounds like nurses, doctors, or respiratory therapists, an understanding of the terminology will help with treatment for clients. Familiarize with these terms as they may be used or documented in the chart or mentioned in team meetings.

Breath Sound Intensity Score (BSI)

  • 0 – none
  • 1 – barely heard
  • 2 – diminished
  • 3 – normal
  • 4 – louder than normal1 

Lung Sounds

Source1 2 

  • Clear – normal inspiration and expiration
  • Adventitious – sound heard in addition (superimposed) to the expected normal lung sounds; likely due to underlying disease
  • Continuous vs. intermittent – e.g., rhonchi and wheezes are continuous versus crackles which are intermittent
  • Absent – indicates respiratory arrest and likely endotracheal intubation
  • Diminished – indicates air or fluid in or around the lungs, an increased chest wall, over-inflation, or reduced airflow. Potential causes include shallow breathing, airway obstruction, bulla (emphysema), hyperinflation, pneumothorax, plural effusion or thickening, and obesity.
  • Exaggerated – common in children and thinner individuals; may indicate lung damage.
  • Adventitious sounds:
    • Crackles – discontinuous, explosive, and nonmusical sounding. They appear in clients with COPD, bronchiectasis, parenchymal lung disease, pneumonia, asbestosis, heart failure, or posture-induced.
    • Wheezing/Rhonchi – same pathology, different sound. Rhonchi is a low-pitched, snoring sound. Wheezes are musical sounds are higher pitched. May be caused by secretions or obstructions in the upper airways. May be a symptom of pneumonia, chronic bronchitis, cystic fibrosis, or COPD.
    • Stridor – a loud, high-pithced musical sound produced only in the upper airways that is mainly inspiratory. Indicates upper-airway obstruction, tracheobronchial lesions, or stenosis.
    • Plueral Rub – a grating sound that sounds like rubbing or is creaky from inflamed plural rubbing against each other. Louder than other adventitious lung sounds.
  • Hamman’s sign – a crunching or crackling sound that is synchronous with the heartbeat. Indicates pneumomediastinum (aka mediastinal emphysema, air is present in the mediastinum) and pneumothorax (collapsed lung).
  1. Zimmerman B, Williams D. Lung Sounds. [Updated 2020 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537253/[↩][↩]
  2. Sarkar, M., Madabhavi, I., Niranjan, N., & Dogra, M. (2015). Auscultation of the respiratory system. Annals of thoracic medicine, 10(3), 158–168. https://doi.org/10.4103/1817-1737.160831[↩]
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