Recognising Abnormal Breath Sounds for Student Nurses
Build confidence recognising common changes in breath sounds, connecting what you hear with the patient's symptoms and observations, and knowing when respiratory findings require escalation.
Why do we listen to breath sounds?
Auscultation allows clinicians to listen to sounds generated as air moves through the respiratory system. Changes in airflow or conditions within the lungs and airways can alter the sounds heard through a stethoscope.
Is air entering both sides?
Compare air entry across corresponding areas rather than listening to one location in isolation.
Can you hear something unexpected?
Wheeze, crackles and other unexpected sounds can provide useful information when interpreted in context.
What does the patient look like?
Respiratory rate, effort, oxygenation, symptoms and consciousness may be more important than the sound itself.
Breath sounds you may encounter
| Finding | What it may sound like | Student nurse focus |
|---|---|---|
| Wheeze | A musical or whistling sound, often more noticeable during expiration. | Recognise the sound, assess the patient's breathing and avoid assuming a specific diagnosis from wheeze alone. |
| Crackles | Discontinuous popping or crackling sounds heard during parts of the respiratory cycle. | Consider where they are heard, the patient's symptoms and the wider respiratory and cardiovascular picture. |
| Reduced air entry | Breath sounds appear quieter than expected in an area or across part of the chest. | Compare both sides and connect the finding with chest movement, respiratory effort and symptoms. |
| Very quiet chest | Markedly reduced respiratory sounds despite significant illness. | In a severely unwell patient this can be particularly concerning and should prompt urgent assessment and escalation. |
| Unexpected upper-airway sound | A harsh or unusual sound may be audible without a stethoscope. | Prioritise airway assessment and obtain urgent help when airway compromise is suspected. |
Recognising wheeze
Wheeze is generally associated with airflow through narrowed airways. The important student-nurse skill is recognising the finding and assessing how unwell the patient is rather than attempting to determine the exact cause independently.
Notice the sound
Wheeze may be widespread or more localised and can vary in intensity.
Look at breathing effort
Respiratory rate, work of breathing, speech and oxygenation help determine the significance of the finding.
Watch for deterioration
Less wheeze does not automatically mean improvement if air movement and the patient's overall condition are worsening.
Recognising crackles
Crackles are short, discontinuous sounds that may be heard during auscultation. They can occur in several different clinical situations, so their meaning depends on the wider assessment.
How to approach respiratory auscultation
Explain and prepare
Explain the assessment, obtain consent and maintain privacy and dignity.
Listen systematically
Follow the auscultation sequence taught within your programme and local clinical setting.
Compare corresponding areas
Comparing similar areas on each side can help identify obvious differences.
Connect what you hear
Interpret breath sounds alongside respiratory rate, effort, oxygenation and symptoms.
When should abnormal breath sounds increase concern?
Increasing respiratory effort
Marked work of breathing alongside abnormal sounds increases concern.
Changing oxygen status
Interpret oxygen saturation against the prescribed target, oxygen therapy and wider clinical picture.
Difficulty communicating
A patient struggling to speak normally because of breathlessness may require urgent assessment.
Confusion or drowsiness
New neurological change alongside respiratory illness is particularly concerning.
One side sounds different
New unilateral findings should be connected with chest movement, symptoms and the wider assessment.
The patient looks seriously unwell
Clinical concern should never be dismissed because one observation remains within an expected range.
If the patient is deteriorating, move beyond auscultation
Airway
Check airway patency and identify any concerning airway sounds or obstruction.
Breathing
Assess rate, depth, effort, chest movement, oxygenation and relevant breath sounds.
Circulation
Assess pulse, blood pressure and peripheral perfusion.
Disability
Identify confusion, drowsiness or reduced consciousness.
Exposure
Consider temperature and other relevant findings while maintaining dignity.
Escalate
Obtain appropriate senior or emergency help according to local procedures when deterioration is suspected.
The breath sounds have changed
Example
A patient who was comfortable earlier becomes increasingly breathless. Their respiratory rate has risen and they are using more effort to breathe.
During supervised auscultation you hear new crackling sounds at the bases of the lungs.
You do not attempt to diagnose the cause from the sound alone. Instead, you recognise the pattern: new breathlessness + rising respiratory rate + increased effort + new auscultation finding.
You complete the appropriate assessment and communicate the change promptly to the registered nurse.
Describe what you hear and what has changed
Example escalation
“I'm concerned about Mrs Lewis. She is more breathless than earlier and her respiratory rate has increased. On supervised auscultation I can hear new crackling sounds at both lung bases.”
This communicates the finding without assigning an unsupported diagnosis.
Errors to avoid
- Trying to diagnose a condition from one breath sound.
- Listening to the chest without first looking at the patient.
- Failing to compare both sides.
- Ignoring respiratory rate and work of breathing.
- Assuming less wheeze always means improvement.
- Focusing on terminology rather than recognising deterioration.
- Delaying escalation while repeatedly trying to identify a sound.
Listen → compare → connect → escalate
Hear the sound — then assess the patient
Breath sounds become clinically useful when they are connected with respiratory rate, breathing effort, oxygenation, symptoms and the patient's overall condition.
Explore Clinical Confidence →