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ULY CLINIC

17 Septemba 2025, 12:02:05

Rhonchi

Rhonchi are continuous adventitious breath sounds heard on auscultation, usually low-pitched, sonorous, or rattling, resembling a deep snore or moan. They result from airflow through narrowed large airways caused by secretions, bronchospasm, tumors, foreign bodies, or mucosal thickening. Sibilant rhonchi (wheezes) are high-pitched. Rhonchi often clear partially with coughing.

Pathophysiology

Rhonchi arise from vibrations of airway walls during airflow:

Airway obstruction: secretions, mucus plugs, tumors, or foreign bodies
Bronchospasm: smooth muscle contraction narrowing bronchi
Mucosal inflammation or edema: viral/bacterial infection, allergy
Post-procedural or therapeutic interventions: bronchoscopy, chest physiotherapy

These factors cause turbulent airflow in large airways, producing characteristic sounds.

History and Physical Examination

History should include:

Onset and progression of cough and breath sounds
Sputum characteristics: color, consistency, odor, hemoptysis
Recent respiratory infections or hospitalizations
Asthma, COPD, cystic fibrosis, or other pulmonary disorders
Medications (bronchodilators, steroids, antibiotics)
Smoking history and exposure to irritants
Systemic symptoms: fever, weight loss, fatigue, dyspnea

Physical examination:

Vital signs including oxygen saturation
Inspect chest for accessory muscle use, nasal flaring, cyanosis
Auscultate for rhonchi, crackles, wheezes, pleural rubs; note location and extent
Percuss lungs for dullness or hyperresonance
Characterize cough: dry or productive
Examine sputum if present

Special considerations: suction if secretions obstruct airways; have bronchodilators and oxygen ready.

Classification of Rhonchi (by Type)

Type	Characteristics	Typical Location	Clinical Notes
Sonorous (low-pitched)	Moaning, snoring, rumbling	Large airways (trachea, bronchi)	Often clears partially with coughing
Sibilant (high-pitched wheeze)	Musical, whistling	Smaller bronchi/bronchioles	Usually associated with bronchospasm; common in asthma
Mixed	Combination	Variable	Seen in severe airway obstruction with secretions

Medical causes

Cause	Laterality	Onset	Key Features	Systemic Signs	Pathophysiology	Management
Asthma	Usually bilateral	Acute or episodic	Wheezing, sonorous rhonchi, prolonged expiration	Tachypnea, tachycardia, accessory muscle use, cyanosis	Bronchospasm, mucus plugging	Bronchodilators, corticosteroids, oxygen therapy
Bronchiectasis	Usually bilateral, lower lobes	Chronic	Productive cough, mucopurulent/foul-smelling sputum, rhonchi	Fever, weight loss, fatigue, clubbing	Permanent airway dilation → mucus accumulation	Antibiotics, chest physiotherapy, bronchodilators
Acute bronchitis	Bilateral	Sudden	Dry cough progressing to productive, scattered rhonchi	Mild fever, malaise, substernal tightness	Mucosal inflammation & bronchospasm	Supportive care, hydration, bronchodilators if wheezing
Chronic bronchitis	Bilateral	Gradual, recurrent	Persistent productive cough, scattered rhonchi, coarse crackles	Cyanosis, tachypnea, barrel chest, clubbing	Chronic airway inflammation and mucus hypersecretion	Bronchodilators, smoking cessation, chest physiotherapy
Pneumonia (bacterial)	Usually unilateral	Acute	Rhonchi, dry → productive cough, pleuritic chest pain	High fever, chills, tachypnea, cyanosis	Airway inflammation, alveolar consolidation	Antibiotics, oxygen, supportive care
Pulmonary coccidioidomycosis	Usually unilateral	Subacute	Rhonchi, wheezing, cough, pleuritic pain	Fever, malaise, weight loss, rash	Fungal infection → airway inflammation	Antifungal therapy, supportive care
Post-procedural / therapy-induced	Variable	Immediate	Rhonchi after bronchoscopy or chest physiotherapy	None systemic	Loosening of airway secretions	Suction, supportive care

Assessment and Diagnostic Workup

Vital signs and oxygen saturation
Auscultation and percussion of lungs
Chest X-ray / CT scan for consolidation, masses, or bronchiectasis
Pulmonary function tests if obstructive lung disease suspected
Sputum analysis and culture for infection
Arterial blood gas in hypoxemic patients

Management principles

Positioning: semi-Fowler’s or upright to ease breathing
Oxygen therapy as needed
Medications: bronchodilators, antibiotics (if bacterial infection), corticosteroids
Pulmonary hygiene: chest physiotherapy, postural drainage, percussion, incentive spirometry
Suctioning to clear secretions if necessary
Hydration and humidification to thin mucus

Patient counseling

Encourage deep breathing and coughing exercises
Increase fluid intake to loosen secretions
Avoid smoking and environmental irritants
Monitor for signs of respiratory distress

Pediatric considerations

Common causes: bacterial pneumonia, cystic fibrosis, croup
Rapid progression possible; monitor for airway obstruction
Auscultation may be limited; observe respiratory effort, retractions, nasal flaring

Geriatric considerations

Reduced airway elasticity may affect sound transmission
Higher risk of adverse reactions to bronchodilators or antibiotics
Chronic conditions may obscure acute changes in auscultation

References

Berkowitz CD. Berkowitz’s Pediatrics: A Primary Care Approach, 4th ed. USA: American Academy of Pediatrics; 2012.
Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008.
Colyar MR. Well-Child Assessment for Primary Care Providers. Philadelphia, PA: F.A. Davis; 2003.
McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Maryland Heights, MO: Mosby Elsevier; 2010.
Sommers MS, Brunner LS. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.