From the Research
To treat rales, addressing the underlying cause of fluid buildup in the lungs is crucial, and the most effective treatment approach includes the use of diuretics like furosemide, as evidenced by the most recent and highest quality study 1. The treatment of rales, also known as crackles, involves a multifaceted approach that targets the removal of excess fluid from the lungs and addresses the underlying cause of the condition.
- Common causes of rales include heart failure, pneumonia, and other respiratory conditions.
- Treatment options may include:
- Diuretics like furosemide (Lasix) at 20-80mg daily to remove excess fluid, as supported by a study comparing intravenous furosemide and nebulized furosemide in patients with pulmonary edema 1.
- Antibiotics if infection is present, such as amoxicillin 500mg three times daily for 7-10 days for pneumonia.
- Bronchodilators like albuterol (2 puffs every 4-6 hours) to open airways if bronchospasm is contributing.
- Oxygen therapy to maintain oxygen saturation above 90%.
- For heart failure causing rales, ACE inhibitors like lisinopril (starting at 2.5-5mg daily) and beta-blockers like metoprolol (starting at 12.5-25mg twice daily) help improve cardiac function.
- Elevating the head of the bed by 30-45 degrees can help ease breathing. The most recent and highest quality study 1 suggests that nebulized furosemide is not superior to intravenous furosemide in reducing dyspnea and crackles in patients with acute pulmonary edema, but it significantly improves respiratory rate and arterial blood oxygen and has less hemodynamic changes than intravenous furosemide. Other studies, such as 2, support the use of non-invasive ventilation in acute cardiogenic pulmonary edema, while 3 suggests that nitrate therapy is an alternative to furosemide/morphine therapy in the management of acute cardiogenic pulmonary edema. However, the most recent and highest quality study 1 takes precedence in guiding treatment decisions. Rales occur because fluid in the alveoli creates popping sounds when air moves through during breathing, so effective treatment focuses on removing this fluid and treating the condition causing it, whether it's heart failure, pneumonia, or another respiratory condition.