Reference — Respiratory
Breath Sounds Reference
Breath sounds are divided into normal sounds (vesicular, bronchovesicular, bronchial) heard in specific locations, and adventitious (abnormal) sounds that indicate underlying pathology. Accurate auscultation and documentation are core nursing skills.
Educational use only. Auscultation findings must be interpreted in the context of the full clinical picture and patient history. Always correlate with vital signs, SpO₂, and provider 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 | Location | Characteristics | Abnormal If Heard At |
|---|---|---|---|
| Vesicular | Most peripheral lung fields | Soft, low-pitched; inspiration longer than expiration (3:1); no pause between I and E | N/A — this is the expected peripheral sound |
| Bronchovesicular | 1st and 2nd intercostal spaces anteriorly; between scapulae posteriorly | Medium pitch; inspiration = expiration (1:1); slight hollow quality | Peripheral fields — suggests consolidation |
| Bronchial (Tracheal) | Over the trachea and manubrium | Loud, high-pitched, harsh; expiration longer than inspiration (2:3); short pause between I and E | Peripheral lung fields = consolidation (classic pneumonia sign) |
Adventitious (Abnormal) Breath Sounds
Crackles (Fine)
When heardLate inspiratory; high-pitched; non-continuous
CauseFluid in small airways/alveoli snapping open at end of inspiration; does not clear with coughing
Clinical significancePulmonary fibrosis, early pulmonary edema, interstitial lung disease
Crackles (Coarse)
When heardEarly inspiratory; low-pitched; may clear with coughing
CauseSecretions in large airways; bubbling quality
Clinical significancePneumonia, COPD with retained secretions, pulmonary edema (later stages), bronchitis
Wheezes
When heardExpiratory > inspiratory; high-pitched; musical, continuous
CauseNarrowed airways (bronchospasm, mucosal edema, secretions) cause turbulent airflow
Clinical significanceAsthma, COPD exacerbation, anaphylaxis, foreign body, CHF
Rhonchi
When heardPredominantly expiratory; low-pitched; snoring or gurgling; may clear with cough
CauseSecretions or obstruction in large airways
Clinical significancePneumonia, bronchitis, COPD, aspiration
Stridor
When heardInspiratory (usually); loud, high-pitched; audible without stethoscope
CauseUpper airway obstruction causing turbulent airflow through a narrowed larynx or trachea
Clinical significanceCroup, epiglottitis, foreign body, post-extubation edema, anaphylaxis — requires immediate assessment
Pleural Friction Rub
When heardBoth inspiration and expiration; leathery or grating; does not change with coughing
CauseInflamed pleural surfaces rubbing against each other (loss of lubricating pleural fluid)
Clinical significancePleuritis, pulmonary embolism, pneumonia near the pleura
Key Differentiation Points
- Stridor vs wheeze: Stridor is inspiratory and is heard with the naked ear — upper airway. Wheeze is expiratory (mostly) and requires a stethoscope — lower airway.
- Crackles vs rhonchi: Crackles do not clear with coughing (fluid/collapsed alveoli). Rhonchi often clear with coughing (secretions in large airways).
- Pleural friction rub vs crackles: Friction rub is heard in both inspiration and expiration. Crackles are predominantly inspiratory. Neither clears with coughing.
- Bronchial sounds peripherally: Bronchial breath sounds heard over peripheral lung fields indicate consolidation — normal lung tissue is replaced by fluid or inflammatory material that conducts sound better.
- Absent sounds: No breath sounds in a lung field suggests pneumothorax, large effusion, or complete atelectasis — requires immediate escalation.
NCLEX Pearls
- ›Stridor = upper airway obstruction emergency — assess immediately and notify provider.
- ›Bronchial breath sounds heard peripherally = consolidation (pneumonia classic finding).
- ›Fine crackles that do NOT clear with coughing = fluid in small airways (pulmonary edema, fibrosis).
- ›Coarse crackles that DO clear with coughing = secretions in large airways (pneumonia, bronchitis).
- ›Pleural friction rub: heard in inspiration AND expiration — differentiates it from crackles.
- ›Absent breath sounds: notify provider — consider pneumothorax, effusion, or ETT displacement.
Related Resources
Breath Sounds Comparison ChartSound, description, cause, and clinical significance — side by side
Open →Respiratory Assessment GuideInspection, palpation, percussion, auscultation — systematic sequence
Open →ARDS FundamentalsBilateral crackles, refractory hypoxemia, and lung-protective ventilation
Open →Pneumonia Assessment and CareLung sounds, sputum, oxygenation monitoring, and nursing priorities
Open →Tracheostomy Care for NursesBedside emergency equipment, suctioning, inner-cannula and stoma care, cuff management
Open →Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Association for Respiratory Care (AARC) · GOLD (COPD) / ATS / CHEST. 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 →