Chest breathing– breathing of strength This type of breathing is used to gain strength during heavy physical labor, such as carrying heavy objects, rolling large stones and heavy tree trunks, as well as in training athletes and divers and in martial arts. Inhale

Breath Next important stage– this is correct breathing during yoga. The living life force of breath is shakti, it is the creative energy of spirituality living in the Universe. For yogis, breath is a replenishment of prana (life force) that flows within us. Breath

These include:
vesicular (alveolar) respiration;
bronchial (laryngotracheal) breathing;
mixed breathing.

Vesicular respiration.

The sound heard on the chest of healthy Animals is in its quality the exact opposite of tracheal breathing. This is a soft, sucking, blowing sound, reminiscent of the soft pronunciation of the sound F. It can be reproduced artificially if, having given the speech organs a setting for the sound F, one takes moderately strong inhalations and exhalations. The strength and pitch of this artificial sound can be varied in almost the same direction in which natural vesicular respiration also changes.

Lennek, the creator of auscultation, explained the occurrence of vesicular breathing by friction of the surface layers of the air stream against the mucous membrane of the lower respiratory tract. This theory does not stand up to criticism, since the surface particles of the air stream adhere tightly to the mucous membrane layer, which makes friction impossible.

According to Baas and Penzold, vesicular breathing is nothing more than a purely conductive sound (the sound of laryngeal constriction), highly modified when passing through the elastic tissue of the lung. However whole line observations and facts contradict this view, which at one time became widespread.

According to Geigel, the cause of vesicular breathing is the high elasticity of the lung tissue, which, expanding at the moment of inhalation, collapses during expiration. This kind of vibration, generated in the countless alveoli of the lung, creates a noise that can be heard throughout the entire inhalation.

According to Marek, vesicular breathing is a complex combined sound. It consists of two components. The main mass of sound is formed in the parenchyma of the lung at the site of the transition of countless bronchioles (respiratory bronchi) into the wide bell of the pulmonary funnels. Mixed with this stenotic sound of the lung is the sound of laryngeal constriction, carried through the respiratory tube system to the lung and somewhat modified when passing through the thickness of the lung and the mass of air contained in it. The detection of vesicular breathing on any part of the chest wall indicates that air penetrates into the alveoli, that their cavity is free. The inhalation is audible all the way from beginning to end, while the exhalation is audible only at the beginning.

The sound heard during expiration is short and weak, according to Marek, and is a remnant of the laryngeal noise of stenosis, somewhat modified by the lung tissue. Thanks to of different durations sounds of inhalation and exhalation, both phases of breathing are easily determined by auscultation.

The nature and strength of vesicular respiration in domestic animals show sharp differences depending on the type of animal, body type and shape of the chest, nutritional status, age and intensity of metabolic processes. It is loudest and sharpest, due to the admixture of the wired sound of the larynx, in carnivores, somewhat weaker and quieter in large animals. cattle. In a horse, vesicular breathing is much more gentle and soft, quieter and weaker than in other animal species. In narrow-chested, poorly nourished horses, it can be heard with sufficient clarity in all areas of the percussion field. However, when good condition nutrition and massive development of the chest, vesicular breathing is clearly audible only over the middle and upper third of the chest. In the area behind the elbow it can be heard only with some difficulty, and often it is not audible at all. Breath sounds in young animals are much stronger, sharper and rougher than in adults (puerile breathing). In old animals, vesicular breathing is heard much weaker than in middle-aged animals.

Poor audibility of breathing sounds in a horse significantly complicates research, especially since not in all cases it is possible to use artificial methods to amplify them. In relation to the horse, special care should be taken to carry out the research methodically, which somewhat facilitates not only the work, but also the assessment of the results obtained.

When analyzing vesicular respiration in a horse, one should therefore be guided by the following experimental data.

1. At rest in healthy horses, the respiratory rate is different areas breasts are not the same. It is heard most strongly above the middle

chest, somewhat weaker in the upper sections and weakest in the area behind the elbow and above the scapula. Cases when breathing is heard with equal force in all parts of the chest should be regarded as increased breathing. Subsequently, it is necessary to find out the reasons for this increase in order to be able to give it a correct assessment.

2. In the same areas of opposite sides, breathing should be heard with equal strength. Variegated breath when on the left, for example, behind the elbow, respiratory sounds are not audible at all, but on the right in the same area they are clear, this is undoubtedly a pathological phenomenon.

Strengthening vesicular breathing can be artificially reproduced by the double sound FF. Uniform strengthening over the surface of the entire lung - general increase in vesicular respiration- observed with various shortness of breath, which is a consequence of increased excitation of the respiratory center. At the same time, breathing becomes somewhat rougher and sharper, and exhalation is longer and can be heard during most of the expiration (hard breathing). This kind of general increase in breathing, highlighting the depth and strength of the toxic effect of various types of pathogens of infectious diseases on the respiratory center, is essentially only a general symptom. It would be a mistake to associate it with damage to the lung parenchyma. From a diagnostic point of view, it is of much greater interest local, or vicarious, increased breathing. At the same time, respiratory sounds are increased only in some parts of the lung, namely where healthy lung tissue takes over the function of its affected areas. With vicarious amplification, breathing at the same time becomes variegated, that is, the intensity of the noise turns out to be different; while in some departments the noises are sharply amplified, in others they are little changed, and in some they are completely absent - respiration nulla, or bronchial breathing. Local increase in vesicular respiration is observed with lobar and catarrhal pneumonia, hyperemia and pulmonary edema, widespread microbronchitis, pulmonary tuberculosis.

Weakening of vesicular respiration is observed in many diseases of the respiratory system. In some cases, for example, with pleurisy and pleurodynia, its cause is painful sensations during expansion of the chest, the excursions of which are therefore arbitrarily limited. In other cases, it is a consequence of fusion of the pulmonary pleura with the costal pleura or thickening of the chest wall, as, for example, with fibrinous pleurisy, tuberculosis lesions pleura. Various types of narrowing of the upper respiratory tract, limiting the possibility of inspiratory expansion of the alveoli, also entail weakening of breathing. With pulmonary emphysema - alveolar and interstitial - it is a consequence of weakened elasticity of the lung. In addition, weakening of vesicular respiration is observed in initial stage lobar pneumonia, with interstitial inflammation of the lung, sebaceous pneumonia, pulmonary edema, with tuberculosis and pulmonary echinococcosis.

The absence of breathing sounds (respiraatio nulla) indicates complete obstruction of the alveolar tissue of the lung and small bronchi. When the alveoli are filled, for example, with fibrinous exudate, or are compressed by pleural effusion, the formation of a stenotic sound of the lung (1st component of vesicular respiration) in the affected area becomes impossible; “If at the same time the bronchi retain conductivity, then bronchial breathing can be heard on the chest, and when the lumen of the bronchi is closed, respiratory sounds completely disappear. Persistent respiratio nulla below the line of dullness is especially characteristic of exudative pleurisy; with lobar pneumonia, respiratio nulla is sometimes replaced by clear bronchial breathing. It is observed much less frequently in catarrhal and interstitial pneumonia, pulmonary atelectasis, pyeumo- and hydrothorax, tuberculosis, glanders, etc.

Bronchial breathing.

In all domestic animals, with the exception of the horse, fairly loud bronchial breathing, albeit mixed with vesicular noise, is clearly audible in the area of ​​the scapulohumeral girdle. It is especially clearly and sharply expressed in dogs. This is the so called normal, or physiological, bronchial breathing should not be confused with pathological, which is important symptom serious illnesses. In a horse, bronchial breathing, wherever it is found, is always pathological.

When analyzing respiratory sounds, it should be remembered that pathological bronchial breathing is usually detected in the lower-posterior parts of the lung, i.e., where inflammatory processes of the lung and pleura most often begin; it is usually heard during both respiratory phases, without any admixture of vesicular breathing, and for the most part is combined with changes in percussion sound (dullness, dullness). When checking detected sounds, it does not hurt to use comparative auscultation, carefully listening to adjacent areas of the lung tissue, comparing the questionable sound with tracheal breathing.

Despite the fact that pure vesicular breathing is always easy to distinguish from tracheal breathing, which is the prototype of bronchial breathing, in pathological cases, extremely unpleasant errors are often observed when assessing respiratory sounds. Bronchial breathing is mixed with vesicular breathing or, more often, increased vesicular breathing is regarded as bronchial breathing. The reason for this type of error lies in changes in the intensity of sounds. Increased vesicular breathing becomes at the same time rough, hard, with a clearly drawn out exhalation. And, conversely, the bronchial, weakening, loses its sonority and becomes much softer, more tender. Thus, the initial difference between the sounds is not so sharp. This is what makes this kind of error possible.

Essentially, bronchial breathing can be considered as a remnant of vesicular noise, which includes as an appendage the sound of laryngeal stenosis carried to the lungs and amplified by resonance. In cases where, due to obstruction of the alveoli - filling them with exudate or compression from the outside - the appearance of vesicular noise becomes impossible, the sound of laryngeal constriction is easily carried through the compacted tissue of the lung to its surface and is heard on the chest as an independent sound.

The most common cause of bronchial breathing is infiltration of large areas of the lung. At superficial location inflamed foci, if only the bronchi have completely retained their conductivity in the corresponding parts of the chest, in such cases it is possible to occasionally listen to more or less sharp bronchial breathing. When the lumen of the bronchus is closed by mucus plugs or exudate, sound conduction is no longer possible, as a result of which bronchial breathing disappears and is replaced by respiratio nulla, which, after removing the mucus plug, again gives way to bronchial breathing. This kind of shift is especially often observed in contagious equine pleuropneumonia.

Based on the nature of the sound, strong and weak, sharp and soft bronchial breathing are distinguished. The intensity of the noise depends on the size and position of the infiltrated focus of the lung and its consistency, and the timbre depends on the properties of the bronchial mucosa. The larger the affected area, the more complete the hepatization of the tissue, the louder and stronger the bronchial breathing.

Most often, the appearance of bronchial breathing is associated with lobar pneumonia, which develops in a number of cases. specific infections: contagious pleuropneumonia of horses, peripneumonia of cattle, hemorrhagic septicemia, second form of swine fever. It is found much less frequently in bronchopneumonia, namely in those, for example, cases where huge infiltrates (drain pneumonia) are formed by the merging of foci. These include: influenza pneumonia of horses, pulmonary paratyphoid fever of calves, pulmonary helminthic disease, enzootic pneumonia of piglets, canine distemper. Sometimes bronchial breathing is also found in tuberculosis, glanders, and chronic interstitial pneumonia.

Much less often, the cause of bronchial breathing is compression of the lung by liquid, which leads to compaction of the parts immersed in it, as a result of which the conditions necessary for the occurrence of vesicular breathing disappear. With exudative pleurisy along the upper line dull sound for a long time clear bronchial breathing can be heard. When the lung fuses with the costal pleura, the later developed exudative pleurisy gives persistent bronchial breathing over the entire surface of the dull sound, which is characterized by amazing purity and clarity. Exactly the same clean and very persistent bronchial breathing characterizes pleurisy with a large accumulation of exudate, when the part of the lung immersed in liquid becomes splenized, while the large and medium bronchi completely retain patency. It is observed much less frequently in dropsy, due to compression of the lung by serous transudate.

Uncertain (mixed) Breathing refers to this type of noise, the properties of which cannot be determined with sufficient clarity. Extremely weak vesicular and low-intensity bronchial breathing in equally are regarded as uncertain. Under normal conditions, vague breathing is often heard in fat, well-built horses above the shoulder blade area with even, calm breathing. After a little wiring, thanks to the amplification, the basic properties of vesicular breathing are clearly distinguished—its extended, blowing inhalation with a short exhalation.

In pathological cases, uncertain breathing is a transitional form from vesicular to bronchial, and vice versa. It is observed in the initial phase of lobar pneumonia, sometimes with bronchopneumonia, with compression of small sections of the lung by exudate and transudate, alveolar pulmonary emphysema, disseminated tuberculosis, as well as significant thickening of the chest wall and its infiltration. In some cases, determining the main breathing noise becomes impossible due to the abundant admixture of extraneous sounds: wheezing, snoring, whistling, snoring.

Further development of the disease process or its extinction, increasing or decreasing the intensity of the main respiratory sounds, makes it possible to evaluate their properties and classify them as one or another type.

Amphoric breathing

represents only special shape bronchial breathing, from which it differs in its softness, depth and clearly expressed metallic tint. By its nature, it resembles that stenotic sound that is formed if a stream of air is forced through the hole in the neck of a bottle. In domestic animals, amphoric breathing is observed relatively rarely. It is sometimes found with gangrene of the lung over large cavities with smooth, even walls communicating through the lumen of the bronchus with the outside air. When percussing the area of ​​amphoric breathing, a tympanic sound is most often detected, less often the sound of a cracked pot or a metallic sound. With the formation of small cavities that do not communicate with each other, auscultation typically reveals bronchial breathing.

Cavities formed due to tuberculosis can also cause amphoric breathing. In addition, it is sometimes found with extensive bronchiectasis and pneumothorax.

(see) and pleural friction noise (see Pleurisy).

Vesicular respiration Normally it is heard over the entire surface of the lungs, but its audibility in different parts of the chest is not the same. It is heard more clearly in the subclavian and subscapular areas, weaker in the inferolateral areas and above the apices of the lungs, where the layer of lung tissue is smaller. In patol conditions, vesicular breathing can be weakened, increased, hard, or heard as saccadic breathing (see).

Bronchial breathing Normally, it is heard over the larynx, trachea, large bronchi, and in case of lung pathology, over areas of their compaction (due to infiltration or compression), as well as over cavities containing air and communicating with the bronchi. In the presence of special conditions of resonance (open pneumothorax, compaction of the lower lobe of the left lung, with a large air bubble and tension of the stomach walls and under some other conditions), bronchial breathing acquires a metallic timbre, characterized by a ringing loud and high tone.

Over large, smooth-walled cavities in the lungs containing air and a small amount of liquid, bronchial breathing often acquires a peculiar musical timbre and is characterized as amphora breathing (Greek, amphora, a vessel with a narrow neck). It is quieter, slightly lower in tone than typical bronchial breathing, and has a musical timbre reminiscent of the sound that occurs when you blow over the narrow neck of a large empty bottle.

Clinical and diagnostic characteristics of D. sh. - see table.

Breath sounds in children

Vesicular breathing in children aged 1 to 7 years has its own characteristics and is referred to as puerile breathing (lat. puer - child). Its main feature is the intensification of exhalation noise and a distinct lengthening of its audibility, which is due to the relative narrowness of the bronchi in children and better sound conduction by the thin and elastic chest wall. It is possible that the peculiarities of puerile breathing are also associated with partial conduction of laryngotracheal (bronchial) breathing onto the chest due to the shorter distance between the glottis and the chest walls than in adults.

In the first year of life, the puerile nature of breathing is not clearly revealed due to the low airiness of the lungs (underdevelopment of the alveoli), the relatively large mass of interstitial tissue in them and the poor development of elastic and muscle fibers. At this age, breathing usually has a weakened vesicular character.

The abundance of connective tissue in the lungs, the tendency to develop edema in it and the relative narrowness of the bronchi determine the earlier appearance of hard breathing in bronchitis and bronchopneumonia in children than in the same diseases in adults.

Bronchial breathing appears under the same patol conditions as in adults. Amphoric breathing is rare, occurring only in school-age children.

The main causes and mechanisms of the formation of dry and wet wheezing in children and adults are the same (see Wheezing), but in the origin of wheezing in children the role of swelling of the bronchial mucosa is more significant, which is facilitated by abundant vascularization of the respiratory organs and poor development of the muscular layer in the bronchi. Good vibration of the chest wall in children sometimes makes it possible to perceive wheezing by palpation when palpating the child’s chest.

Crepitus in children, as in adults, occurs with pneumonia, but in children early age due to shallow and weakened breathing, it is not always heard; deepening the child’s breathing when crying or changing body position helps to identify it.

With the accumulation of effusion in the pleural cavity D. sh. become weakened, but in children, unlike adults, they do not disappear completely, which is explained by the increased conductivity of sound in children through the thin chest wall and the small volume of the chest.

Table. CLINICAL AND DIAGNOSTIC CHARACTERISTICS OF BREATH SOUND

Bibliography: Vasilenko V. X. et al. Propaedeutics of internal diseases, p. 100, M., 1974; Dombrovskaya Yu. F., L e-bedev D. D. and MolchanovV. I. Propaedeutics of childhood diseases, p. 235, M., 1970; Shelagurov A. A. Research methods in the clinic of internal diseases, p. 77, M., 1964.

I. P. Zamotaev; A. G. Gracheva, N. A. Tyurin (ped.).