Is expiration rhonchi an expected finding in a patient with a void in their medical history or current condition, particularly in relation to respiratory issues such as chronic obstructive pulmonary disease (COPD) or asthma?

Expiratory Rhonchi and COPD

Expiratory rhonchi are NOT an expected finding in a "void" (absence of disease), but ARE a common and expected finding in patients with COPD, chronic bronchitis, bronchiectasis, and other obstructive airway diseases characterized by mucus hypersecretion and airway narrowing.

Understanding the Clinical Context

The term "void" in your question likely refers to either:

• An absence of significant pathology (normal patient)
• A void/gap in medical history documentation

In a healthy patient without respiratory disease, expiratory rhonchi should NOT be present. 1

When Expiratory Rhonchi ARE Expected

COPD and Chronic Bronchitis

• Patients with COPD, particularly those with chronic bronchitis phenotype, commonly present with expiratory rhonchi due to mucus accumulation and airway narrowing. 2
• COPD patients are typically >50 years old, long-term smokers with chronic breathlessness on minor exertion, and often have morning cough with discolored sputum production. 1
• The presence of rhonchi in COPD reflects the "bronchitic" component with mucus hypersecretion and airway inflammation. 2

Bronchiectasis

• Patients with bronchiectasis frequently have expiratory rhonchi due to fixed airflow obstruction and chronic mucus production. 2
• Bronchiectasis presents with persistent mucopurulent or purulent sputum production and recurrent chest infections. 2
• These patients may also be at risk for hypercapnic respiratory failure, similar to COPD patients. 2

Other Conditions with Expected Rhonchi

• Asthma during exacerbations may present with expiratory wheezes and rhonchi, though typically more wheezing predominates. 2, 3
• Tracheomalacia or bronchomalacia can produce expiratory sounds due to dynamic airway collapse. 2

Key Distinguishing Features

Physical Examination Priorities

• Assess for respiratory distress markers including audible wheeze, tachypnea, accessory muscle use, and signs of chronic overinflation. 1
• Central cyanosis indicates significant hypoxemia but its absence does not exclude it. 1
• Rhonchi that clear with coughing suggest mobile secretions rather than fixed obstruction. 4

Diagnostic Approach When Rhonchi Present

• Spirometry is mandatory when the patient is stable—degree of airways obstruction cannot be predicted from symptoms or physical signs alone. 1
• Chest radiography should be obtained to exclude pneumonia, pulmonary edema, or other acute processes. 2, 1
• For patients >50 years who are long-term smokers with chronic breathlessness and rhonchi, assume COPD until proven otherwise. 2, 1

Common Pitfalls to Avoid

• Do not assume rhonchi are "normal" or benign—they indicate airway pathology requiring investigation. 4
• In patients with suspected COPD presenting with rhonchi, limit initial oxygen to 28% via Venturi mask or 2 L/min via nasal cannulae until blood gas results are available to prevent hypercapnic respiratory failure. 2, 1
• Target oxygen saturation of 88-92% in suspected COPD rather than normal saturation. 2, 1
• Excessive oxygen administration (>35% or PaO₂ >10 kPa/75 mmHg) in COPD patients with rhonchi can cause CO₂ retention and respiratory acidosis. 2

Clinical Significance

The presence of expiratory rhonchi should prompt evaluation for underlying obstructive lung disease, particularly COPD in smokers >50 years old, or bronchiectasis in patients with chronic productive cough. 2, 1, 4 These findings are NOT normal and require diagnostic workup including spirometry, chest imaging, and consideration of arterial blood gas measurement if respiratory compromise is suspected. 1