Airflow effects on amplitude and spectral content of normal breath sounds

Even though it is well known that breath-sound amplitude (BSA) increases with airflow, the exact quantitative relationships and their distribution within the relevant frequency range have not yet been determined. To evaluate these relationships, the spectral content of tracheal and chest wall breath sounds was measured during breath hold, inspiration, and expiration in six normal men. Average spectra were measured at six flow rates from 0.5 to 3.0 l/s. The areas under the spectral curves of the breath sounds minus the corresponding areas under the breath-hold spectra (BSA) were found to have power relationships with flow (F), best modeled as BSA = k.F alpha, where k and alpha are constants. The overall mean +/- SD value of the power (alpha) was 1.66 +/- 0.35, significantly less than the previously reported second power. Isoflow inspiratory chest wall sound amplitudes were 1.99 +/- 0.70- to 2.43 +/- 0.65-fold larger than the amplitudes of the corresponding expiratory sounds, whereas tracheal sound amplitudes were not dependent on respiratory phase. Isoflow breath sounds from the left posterior base were 32% louder than those from the right lung base (P < 0.01). BSA-F relationships were not frequency dependent during expiration but were significantly stronger in higher than in lower frequencies during inspiration over both posterior bases. These data are compatible with sound generation by turbulent flow in a bifurcating network with 1) flow separation, 2) downstream movement of eddies, and 3) collision of fast-moving cores of the inflowing air with carinas, all occurring during inspiration but not during expiration.