Bronchial breathing

In 1816, the Parisian physician Rene Theophile Hyacinthe Laennec (1781 - 1826) rolled up some notebooks to make a makeshift hearing aid so that he would not have to place his ear on a patient's portly chest. To his surprise, he heard heart sounds loud and clear. He then turned a wooden ear trumpet, which he called a "stethoscope" (Greek: chest viewer). In the same year, Laennec became chief physician of a Parisian clinic, where mainly lung patients were treated. He used the ear trumpet regularly during his rounds and developed a vocabulary for normal, abnormal and pathological sounds (Schoon 2012).

Bronchial breathing is a special form of breathing in which the alveoli do not participate in respiration (Edens 1920).

Auscultatorily, bronchial breathing sounds like a sharp "ch", which is produced by very high vibrations. It is usually better auscultated during expiration. It differs from vesicular breathing in its sound character, pitch, but not in its loudness. (Neuhaus 2013).

Bronchial breathing results in attenuation during percussion and enhancement of bronchophony (Dahmer 2006). In addition, the expirium is prolonged (Lasserre 2002).

However, sensitivity and specificity of bronchial breathing with respect to pathology are low (Herold 2022).

Breath sounds are differentiated by a change in the number of vibrations of the fundamental tones between:

• vesicular breathing (normal) 120 vibrations per second
• bronchovesicular breathing 250 - 500 vibrations per second.
• Bronchovesicular breathing ≥ 1,000 vibrations per second (Dahmer 2006).

The main amplitude in bronchial breathing is usually even between 2,000 - 4,000 Hz (Neuhaus 2013).

Bronchial breathing need not be pathological in principle: in healthy individuals it is auscultable over the trachea and main bronchi (Lasserre 2002).

It may otherwise occur as a physical sign in the context of the following diseases:

• Infiltration in pneumonia (Herold 2022).
• Infiltrates in tuberculosis
• Compression of the lung above pleural exudates
• Caverns (Neuhaus 2013)

Bronchial breathing occurs because the underlying lung has become airless due to, for example, infiltrates, caverns, etc.

This results in oscillations of the tracheobronchial system with vortex formation of the respiratory air in the area of the bronchial branches (Lasserre 2002).

The airless districts of the lungs can no longer transmit the low-pitched sounds produced by the air content of the lungs to the chest wall.

In the case of infiltrates located deep in the lungs and surrounded by air-containing lung tissue, vesicular breathing can be heard instead, since bronchial breathing does not result from the formation of cavities, but from the compression of the lung tissue in the surrounding area.

Therefore, bronchial breathing can only be heard when the supplying bronchi are clear. This is also the reason why bronchial breathing cannot be auscultated by e.g. secretions or a carcinoma and instead breathing is suspended (Neuhaus 2013).

• Puerile breathing:

In this case, a clearly tightened expirium can be auscultated over the entire lung on both sides. This occurs especially in very slim people and is not pathological. It is best distinguished from bronchial breathing by its bilateral nature (Holldack 2005).

• Broncho- Vesicular Breathing:

This form of breathing is intermediate between vesicular and bronchial breathing. It indicates that the air content at the auscultated site is not normal (Bach- Marburg 2013). It is not uncommonly found in healthy children at a younger age (Dahmer 2006).

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