From the Guidelines
Rhonchi can be a sign of asthma, but they are not specific to asthma alone, and a definitive diagnosis of asthma should be based on a combination of clinical history, symptoms, and objective measures of lung function, as recommended by the most recent guidelines 1.
Definition and Pathophysiology of Asthma
Asthma is a complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation, as defined by the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma 1. The symptoms of asthma tend to be variable, intermittent, worse at night, and provoked by triggers including exercise, and may include wheezing, shortness of breath, chest tightness, and cough.
Clinical Presentation and Diagnosis
The hallmark of asthma is that these symptoms tend to be variable and intermittent, and a diagnosis should be based on a history of recurrent episodes of coughing or wheezing, especially when these episodes are related to typical precipitants and are relieved by beta-adrenergic agents, as recommended by the guidelines 1. The presence of bronchial hyperresponsiveness by methacholine bronchial provocation or by exercise test also supports the diagnosis of asthma.
Breath Sounds in Asthma
Rhonchi are low-pitched, continuous, rumbling sounds heard during breathing that indicate the presence of secretions or obstruction in the larger airways, and can be a sign of asthma, but are not specific to asthma alone. Asthma more typically presents with wheezing (high-pitched whistling sounds), especially during exhalation, along with cough, chest tightness, and shortness of breath. During an asthma examination, a healthcare provider may hear various breath sounds including wheezes, rhonchi, or even normal breath sounds depending on the severity and stage of the asthma episode.
Evaluation and Management
If rhonchi are detected during a respiratory assessment, further evaluation is needed to determine the underlying cause, which could be asthma or another respiratory condition. The evaluation should include a combination of clinical history, symptoms, and objective measures of lung function, such as pulmonary function tests (FEV, FEF50) and evidence of reversibility (e.g., 12% improvement of FEV after albuterol inhalation) 1. The management of asthma should be based on the severity of the symptoms and the response to treatment, and may include the use of short-acting reliever medications (e.g., albuterol) and controller medications (e.g., inhaled corticosteroids or leukotriene modifiers) 1.
From the Research
Rhonchi as a Sign of Asthma
- Rhonchi are a type of wheezing sound that can be a symptom of asthma, but the provided studies do not directly address whether rhonchi are a definitive sign of asthma 2, 3, 4, 5, 6.
- Asthma is a complex condition characterized by inflammation, airway hyperresponsiveness, and variable airflow limitation, and its diagnosis and management involve a comprehensive approach 4.
- The studies focus on the treatment and management of asthma, including the use of inhaled corticosteroids, long-acting beta-agonists, and other therapies, but do not specifically discuss rhonchi as a diagnostic criterion 2, 3, 5, 6.
Diagnostic Criteria for Asthma
- The diagnosis of asthma involves a combination of clinical symptoms, spirometry, and bronchial provocation tests, among other factors 4.
- The presence of wheezing, coughing, shortness of breath, and chest tightness can be indicative of asthma, but a definitive diagnosis requires a comprehensive evaluation 4.
- Rhonchi, as a type of wheezing sound, may be a symptom of asthma, but its presence alone is not sufficient for a diagnosis 2, 3, 4, 5, 6.
Management of Asthma
- The management of asthma involves a stepwise approach, with treatments ranging from as-needed bronchodilators to combination therapies with inhaled corticosteroids and long-acting beta-agonists 2, 3, 4, 5, 6.
- The goal of asthma management is to achieve and maintain control of symptoms, prevent exacerbations, and improve quality of life 4.
- While rhonchi may be a symptom of asthma, the provided studies do not discuss its specific role in guiding treatment decisions 2, 3, 4, 5, 6.