A 66 year-old male with a history of hypertension and COPD presents with shortness of breath. He states that his symptoms are unimproved with home nebulizer treatments and denies fever, cough or new sputum production. On examination, he has stridor appreciated during inspiratory and expiratory phases.
An inspiratory, expiratory, or continuous monophonic sound that is loudest over the central airways.
A musical, high-pitched sound – more commonly expiratory. Requires sufficient airflow to induce airway oscillations.
Supraglottic: negative intratracheal pressure during inspiration causes airway collapse.
Glottic/Subglottic: fixed obstruction not impacted by changes in luminal/thoracic pressure.
Intrathoracic: increased pleural pressure compresses the narrowed airway.
An Algorithm for the Diagnosis of Wheezing and Stridor
- Sicari V, Zabbo CP. Stridor. [Updated 2021 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525995/
- Patel PH, Mirabile VS, Sharma S. Wheezing. [Updated 2021 May 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482454/
- Bohadana A, Izbicki G, Kraman SS. Fundamentals of lung auscultation. N Engl J Med. 2014;370(21):2053.
- Orient JM, Sapira JD. Sapira’s Art & Science of Bedside Diagnosis. 4th ed. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010.