Breath Sounds From Basic Science to Clinical Practice PDF
Preview Breath Sounds From Basic Science to Clinical Practice
Breath Sounds From Basic Science to Clinical Practice Kostas N. Priftis Leontios J. Hadjileontiadis Mark L. Everard Editors 123 Breath Sounds Kostas N. Priftis Leontios J. Hadjileontiadis • Mark L. Everard Editors Breath Sounds From Basic Science to Clinical Practice Editors Kostas N. Priftis Leontios J. Hadjileontiadis Children’s Respiratory and Allergy Unit Department of Electrical & Computer Third Department of Paediatrics Engineering “Attikon” Hospital Aristotle University of Thessaloniki National and Kapodistrian University Thessaloniki of Athens Greece Athens Greece Mark L. Everard Division of Child Health University of Western Australia Perth Children’s Hospital Perth Australia ISBN 978-3-319-71823-1 ISBN 978-3-319-71824-8 (eBook) https://doi.org/10.1007/978-3-319-71824-8 Library of Congress Control Number: 2018938548 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface It is now just over 200 years since René-Théophile-Hyacinthe Laennec invented the stethoscope and 2018 will be the bicentennial of the publication of his masterpiece, A treatise on the diseases of the chest and on mediate auscultation. The intervening centuries have seen the stethoscope becoming a ubiquitous tool that is synonymous, in the minds of the general public, with the medical profession. Despite repeated reports of its imminent demise, the stethoscope continues to evolve and contribute to clinical care throughout the world. In light of the imminent anniversary of Laennec’s textbook, it seems appropriate to revisit the role of this inexpensive tool in the assessment of respiratory health and disease and consider its future in a world in which the conventional stethoscope is, in a number of settings, being replaced by increasingly sophisticated electronic devices. This publication is not intended to be a classical ‘textbook’, but rather a ‘state-of-the-art’ review on specific clinical and research topics on the subject of respiratory sounds. The starting point was the training of the clinician: from the student to the chest physician. At the same time, the goal was to allow the clinician to talk to the scientist and get an idea of the cutting edge of relevant technology and research. The book is divided in four parts. The first part covers a wide spectrum of general issues regarding the history of stethoscope, the clinical usefulness, epidemiology and nomenclature of breath sounds. The second part of the book is mainly devoted to the science, i.e. sound recording, analysis and perception. The third part deals with clinical issues regarding adventitious respiratory sounds, laryngeal origin sounds, sleep and cough sounds. Finally, the fourth part chapters emphasise a view of the future. In order to provide the most comprehensive picture of the past, present and future evolution of the stethoscope, from the original roll of parchment to its highly sophis- ticated electronic descendants that connect to the Internet and provide computerised analysis, experts from a range of backgrounds were invited to share their knowl- edge. We are grateful to all the authors for their effort, time and efficiency in this common endeavour. v vi Preface We are indebted to the publisher, Springer International Publishing AG, for adopting and supporting this project. Special thanks and gratitude go to Donatella Rizza for her expert advice and editorial organisation. We are also grateful to Barbara Pittaluga and Rekha Udaiyar for their patience and help. Athens, Greece Kostas N. Priftis Thessaloniki, Greece Leontios J. Hadjileontiadis Perth, Australia Mark L. Everard Contents 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Andrew Bush Part I General Consideration 2 The Stethoscope: Historical Considerations . . . . . . . . . . . . . . . . . . . . . . 15 Robert Lethbridge and Mark L. Everard 3 Clinical Usefulness of Breath Sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Sotirios Fouzas, Michael B. Anthracopoulos, and Abraham Bohadana 4 Breath Sounds in Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Patricias W. Garcia-Marcos, M. Innes Asher, Philippa Ellwood, and Luis Garcia-Marcos 5 Nomenclature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Hasse Melbye Part II Sound Recording, Analysis and Perception 6 Physics and Applications for Tracheal Sound Recordings in Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Thomas Penzel and AbdelKebir Sabil 7 Sound Transmission Through the Human Body . . . . . . . . . . . . . . . . . 105 Steve S. Kraman 8 Breath Sound Recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Yasemin P. Kahya 9 Current Techniques for Breath Sound Analysis . . . . . . . . . . . . . . . . . . 139 Leontios J. Hadjileontiadis and Zahra M. K. Moussavi vii viii Contents Part III Respiratory Sounds 10 Normal Versus Adventitious Respiratory Sounds . . . . . . . . . . . . . . . . 181 Alda Marques and Ana Oliveira 11 Wheezing as a Respiratory Sound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Grigorios Chatziparasidis, Kostas N. Priftis, and Andrew Bush 12 Crackles and Other Lung Sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Konstantinos Douros, Vasilis Grammeniatis, and Ioanna Loukou 13 Respiratory Sounds: Laryngeal Origin Sounds . . . . . . . . . . . . . . . . . . 237 Nicola Barker and Heather Elphick 14 Sleep Evaluation Using Audio Signal Processing . . . . . . . . . . . . . . . . . 249 Yaniv Zigel, Ariel Tarasiuk, and Eliran Dafna 15 Cough Sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 Saikiran Gopalakaje, Tony Sahama, and Anne B. Chang Part IV Where Are We Going? 16 Future Prospects for Respiratory Sound Research . . . . . . . . . . . . . . . 291 Alda Marques and Cristina Jácome 17 In Pursuit of a Unified Nomenclature of Respiratory Sounds . . . . . . 305 Kostas N. Priftis, Maria Antoniadi, and Hans Pasterkamp 18 Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 Mark L. Everard, Kostas N. Priftis, and Leontios J. Hadjileontiadis Introduction 1 Andrew Bush A long time ago in a galaxy far, far away, I started in the University College Hospital London medical school and purchased my first stethoscope, which consisted of a bell and a diaphragm joined by a rubber tube to two earpieces. At that time, tele- phone calls were made on Bakelite telephones with a circular dial, and one inserted a finger into the appropriate hole and rotated it; urgent communications were by telegram at a given cost per word; and lecturers used glass-mounted slides or drew on the blackboard to illustrate their talks. After nearly 40 years as a doctor, and more than a quarter of a century of consultant practice, smartphones are replete with unbelievable quantities of APPs, computing and storage power; the telegram is as dead as the dinosaurs, and instead social media such as Facebook, Instagram, Snapchat and Twitter rule; and PowerPoint reigns supreme in the conference and lecture room. And lo! My stethoscope still consists of a bell and a diaphragm joined by a rubber tube to two earpieces. It is difficult to believe that this medical stagna- tion in the face of so much technological transformation elsewhere reflects much credit on anyone. So where are we, and where are we going: and the main purpose of this book is to review exactly this. This introduction is intended to set the scene by being a provocative look at past, present and future chest auscultation, in order to stimulate thought (and possibly rage!) in the interested reader. AB is an NIHR Senior Investigator and additionally was supported by the NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London. A. Bush, MD, FRCP, FRCPCH, FERS, FAPSR National Heart and Lung Institute, London, UK Imperial College, London, UK Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK Royal Brompton Harefield NHS Foundation Trust, London, UK e-mail: [email protected]; [email protected] © Springer International Publishing AG, part of Springer Nature 2018 1 K. N. Priftis et al. (eds.), Breath Sounds, https://doi.org/10.1007/978-3-319-71824-8_1 2 A. Bush 1.1 The Thoracic Cage as Checkpoint Charlie: The Good, the Bad and the Totally Unintelligent An important evolutionary task is to protect the organism from external assaults such as heat, cold and a well-directed spear by encasing it in protection either natu- ral (e.g. bones, a thick hide, scales or a shell) or artificially manufactured armour. The thoracic cage gives good protection to the heart and lungs, but this natural protective layer has the undesirable effect of muffling or eliminating many signals of disease from within the organism, the discernment of which may allow a benefi- cial intervention. This was of small concern when there were no such interventions, and all the physician had to offer amounted to little more than tea and sympathy. In the twenty-first century, the field has changed: • We have ever more powerful diagnostic tests which completely bypass the pro- tective layers, such as HRCT, MRI and other imaging modalities, to say nothing of sophisticated biological tests including genetics, ciliary function and increas- ingly likely -omics technology. • There are increasingly precise therapeutics, such as the designer molecules for gene class-specific mutations in cystic fibrosis [1, 2] and an increasingly formi- dable array of monoclonals for asthma [3, 4]. • We are moving further away from asking ‘are you feeling better’ to the use of specific biomarkers and molecular tests for diagnosis [5] and to monitor disease progression [6]. • Non-invasive testing in preschool infants and even babies is increasingly moving out of the research field and into the routine clinical arena [7]. So, for example, sputum induction for the diagnosis of tuberculosis is being performed in primary health-care centres in South African townships [8], and multiple breath washouts are feasible in clinical settings [9, 10]. So has the time come for the clinician to be pensioned off in favour of a more cheerful version of Douglas Adams’s Marvin the severely depressed and bored robot with a brain the size of a planet (The Hitchhikers Guide to the Galaxy)? Paradoxically, the greater technological advances mean that clinical skills become more, not less, important. So not every child with a runny nose can or should have nasal nitric oxide, assessment of ciliary beat frequency and pattern, ciliary electron microscopy and electron microscopic tomography, whole exome sequencing, cili- ary immunofluorescence and finally ciliary culture lest a diagnosis of primary cili- ary dyskinesia is missed [11, 12]. The clinical skill that is absolutely essential is to pick out the handful of such children in whom this diagnosis should be pursued at all hazard [13–16]. To do this, old-fashioned skills of history and physical examina- tion must be deployed but with two important caveats: firstly, we must not be com- placent but accept that these can and should be honed, and secondly, we need to recognise when the patient’s journey has reached the point when clinical skills are no longer useful.
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