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dc.contributor.authorMelbye, Hasse
dc.contributor.authorAviles Solis, Juan Carlos
dc.contributor.authorJacome, Cristina
dc.contributor.authorPasterkamp, Hans
dc.date.accessioned2022-01-21T10:30:37Z
dc.date.available2022-01-21T10:30:37Z
dc.date.issued2021-03-05
dc.description.abstractBackground The significance of pulmonary crackles, by their timing during inspiration, was described by Nath and Capel in 1974, with early crackles associated with bronchial obstruction and late crackles with restrictive defects. Crackles are also described as ‘fine’ or ‘coarse’. We aimed to evaluate the usefulness of crackle characteristics in the diagnosis of chronic obstructive pulmonary disease (COPD).<p> <p>Methods In a population-based study, lung sounds were recorded at six auscultation sites and classified in participants aged 40 years or older. Inspiratory crackles were classified as ‘early’ or ‘late and into the types’ ‘coarse’ and ‘fine’ by two observers. A diagnosis of COPD was based on respiratory symptoms and forced expiratory volume in 1 s/forced inspiratory vital capacity below lower limit of normal, based on Global Lung Function Initiative 2012 reference. Associations between crackle characteristics and COPD were analysed by logistic regression. Kappa statistics was applied for evaluating interobserver agreement.<p> <p>Results Of 3684 subjects included in the analysis, 52.9% were female, 50.1% were ≥65 years and 204 (5.5%) had COPD. Basal inspiratory crackles were heard in 306 participants by observer 1 and in 323 by observer 2. When heard bilaterally COPD could be predicted with ORs of 2.59 (95% CI 1.36 to 4.91) and 3.20 (95% CI 1.71 to 5.98), annotated by observer 1 and 2, respectively, adjusted for sex and age. If bilateral crackles were coarse the corresponding ORs were 2.65 (95% CI 1.28 to 5.49) and 3.67 (95% CI 1.58 to 8.52) and when heard early during inspiration the ORs were 6.88 (95% CI 2.59 to 18.29) and 7.63 (95%CI 3.73 to 15.62). The positive predictive value for COPD was 23% when early crackles were heard over one or both lungs. We observed higher kappa values when classifying timing than type.<p> <p>Conclusions ‘Early’ inspiratory crackles predicted COPD more strongly than ‘coarse’ inspiratory crackles. Identification of early crackles at the lung bases should imply a strong attention to the possibility of COPD.en_US
dc.identifier.citationMelbye H, Aviles Solis Aviles-Solis JC, Jacome C, Pasterkamp H. Inspiratory crackles-early and late-revisited: identifying COPD by crackle characteristics. BMJ Open Respiratory Research. 2021:266-272en_US
dc.identifier.cristinIDFRIDAID 1982660
dc.identifier.doi10.1136/bmjresp-2020-000852
dc.identifier.issn2052-4439
dc.identifier.urihttps://hdl.handle.net/10037/23747
dc.language.isoengen_US
dc.publisherBMJ Publishing Groupen_US
dc.relation.journalBMJ Open Respiratory Research
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2021 The Author(s)en_US
dc.titleInspiratory crackles-early and late-revisited: identifying COPD by crackle characteristicsen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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