Chart — Respiratory
Breath Sounds Comparison Chart
A complete side-by-side reference for all normal and adventitious breath sounds — sound quality, cause, and clinical significance in one scannable chart.
Educational use only. Auscultation findings must be interpreted in clinical context. Always correlate breath sounds with vital signs, SpO₂, history, and full physical assessment. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Normal Breath Sounds
| Sound | Description | Cause | Clinical Significance |
|---|---|---|---|
| Vesicular | Soft, low-pitched, rustling; inspiration longer than expiration (3:1); no pause between phases | Air moving through small airways and alveoli; normal peripheral lung sound | Normal finding over most lung fields — expected; absence is abnormal |
| Bronchovesicular | Medium pitch; inspiration = expiration (1:1); slightly hollow quality | Air moving near major bronchi (1st–2nd ICS anteriorly, between scapulae posteriorly) | Normal at those locations; heard peripherally = consolidation |
| Bronchial (Tracheal) | Loud, high-pitched, harsh; expiration longer than inspiration (2:3); pause between I and E | Large airway turbulence over trachea and manubrium | Normal over trachea; heard peripherally = consolidation (classic pneumonia sign) |
Adventitious (Abnormal) Breath Sounds
| Sound | Description | Cause | Clinical Significance |
|---|---|---|---|
| Fine Crackles | Late inspiratory; high-pitched; brief; non-continuous; like hair rubbing near ear | Fluid in small airways/alveoli snapping open at end-inspiration; surfactant dysfunction | Pulmonary fibrosis, early pulmonary edema, interstitial lung disease — does NOT clear with cough |
| Coarse Crackles | Early inspiratory; low-pitched; bubbling or gurgling; may clear with cough | Secretions in large airways; air moving through fluid | Pneumonia, COPD with secretions, pulmonary edema — MAY clear with cough |
| Wheezes | High-pitched, musical, continuous; predominantly expiratory; may be inspiratory in upper airway | Narrowed airways (bronchospasm, mucosal edema, secretions) → turbulent airflow | Asthma, COPD exacerbation, anaphylaxis, CHF, foreign body — expiratory = lower airway |
| Rhonchi | Low-pitched; snoring or gurgling; predominantly expiratory; clears with cough | Secretions or partial obstruction in large airways | Pneumonia, bronchitis, COPD, aspiration — clears with cough (differentiates from crackles) |
| StridorEmergency | Loud, high-pitched, inspiratory; audible without stethoscope | Upper airway obstruction (larynx, trachea) → severe turbulence through critically narrowed airway | Croup, epiglottitis, foreign body, post-extubation edema, anaphylaxis — EMERGENCY |
| Pleural Friction Rub | Leathery or grating; heard on both inspiration and expiration; does NOT change with cough | Inflamed pleural surfaces rubbing together; loss of lubricating pleural fluid | Pleuritis, pneumonia near pleura, pulmonary embolism — not affected by coughing |
Key Differentiators
| Question | Answer |
|---|---|
| Clears with coughing? | Yes = rhonchi (secretions). No = crackles (fluid/collapsed alveoli), friction rub, stridor |
| Inspiratory vs expiratory? | Crackles = inspiratory. Wheezes = mainly expiratory (lower airway). Stridor = inspiratory (upper airway). Friction rub = both. |
| Upper vs lower airway? | Stridor = upper (larynx/trachea). Wheezes, crackles, rhonchi = lower airways |
| Bronchial sounds in peripheral fields? | = Consolidation (pneumonia) — solid tissue conducts sound better than air-filled lung |
| Absent breath sounds? | = Pneumothorax, large effusion, atelectasis, right mainstem intubation — escalate immediately |
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with ATS / ACCP Respiratory Assessment Standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →