EpistemisAuscultatory rhoncus
Specialty: Respiratory.
Why it occurs
- Acute or chronic bronchitis with hypersecretion of dense mucus (continuous, low-pitched noises with a harsh musical character, generated by the vibration of thick secretions and the turbulent passage of air through narrowed medium- and large-caliber bronchi; they characteristically change or disappear with cough)
- Reacerbated COPD with severe mucus retention in large airways
- Infected bronchiectasis with ineffective mucociliary clearance
- Bronchial asthma with thick mobile intracavitary or intraluminal mucus plugs
- Partial obstruction of a large bronchus due to a mobile foreign body or slow-growing mass.
Initial workup
Chest x-ray (rule out atelectasis, infiltrates or signs of hyperinflation); Spirometry (evaluate airflow limitation); Microbiological analysis of sputum if they are persistently purulent in nature; Flexible bronchoscopy if the noise is strictly localized and does not vary after vigorous coughing maneuvers.
red flags
Persistent rhonchi that do not vary with cough or the mobilization of secretions associated with severe dyspnea, supraclavicular indrawing, cyanosis, or progressive decrease in vesicular murmur that suggests obstructive lobar atelectasis secondary to complete mucosal plugging.
Standard management
- Acetylcysteine — 600 mg orally once a day to reduce the viscosity of mucus that is difficult to clear
- Salbutamol — 100-200 micrograms inhaled every 6 hours to dilate the airway and facilitate clearance
- IPratropium bromide (40 micrograms inhaled every 8 hours).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 5
- Treatment options
- 3