The Description of Adventitious Lung Sounds by Physician Assistants

The objectives of this study were to (1) assess the terminology used by physician assistants (PAs) in describing adventitious lung sounds (ALS), (2) identify the relationship between background variables and the terms used to describe ALS, and (3) identify the ability of PAs to accurately recognize various ALS. Methods: We surveyed 115 PAs who listened to five different ALS and wrote descriptions of each sound. We used the chi-square test to assess the relationship between the terms used and background variables. Results: One hundred and one (88%) of the participants described sound 1 (fine inspiratory discontinuous ALS) as “rales” or “crackles.” Sound two (coarse discontinuous ALS) was described as “rhonchi” by 58 participants (50%). Sound 3 (polyphonic high-pitched continuous ALS) was described as “wheeze” by 90 participants (78%). Sound 4 (low-pitched monophonic continuous ALS) was described with a variety of terms but most often as “rhonchi” or “wheeze” by 31 participants (27%). Sound 5 (high-pitched monophonic ALS) was described as “wheeze” or “stridor” by 84 participants (74%). Only 36 of the 115 participants used a qualifying adjective to describe the ALS. Years of experience was positively correlated with the ability of the participants to correctly identify sound 1. The overall accuracy of the PAs was 58% in describing the ALS samples. This accuracy level is very similar to those of respiratory therapists and physicians reported in previous studies. Conclusions: PAs use the terms “rales” and “crackles” interchangeably to describe discontinuous ALS. They use the term “rhonchi” inappropriately to describe discontinuous ALS associated with excessive secretions. High-pitched polyphonic and monophonic wheezing were well recognized, but low-pitched wheezing was not and was described inconsistently. The majority of the PAs in this study did not use a qualifying adjective. The PAs participating in this study are skilled at identifying most ALS and compare favorably to the aforementioned health care professions. PA educators ar