Crackles, also known as rales, are an abnormal breathing sound that can be heard on auscultation of the lungs. They indicate fluid or inflammation in the small airways and alveoli of the lungs. Coughing is a reflex response to irritation or inflammation in the airways and can help clear secretions from the lungs. So can coughing help clear crackles from the lungs?
What are crackles?
Crackles are discontinuous, interrupted, explosive lung sounds that sound like salt and pepper being sprinkled onto a sheet of paper. They occur when air opens closed airways or moves through fluid-filled airways in the lungs. The sounds can be coarse or fine:
- Fine crackles are high-pitched, soft, and popping.
- Coarse crackles are lower-pitched, louder, and bubbly.
Crackles typically occur in lung diseases that cause inflammation and/or fibrosis of the interstitium or fluid accumulation in the alveoli and bronchi of the lungs. Conditions associated with crackles include:
- Pneumonia
- Pulmonary edema
- Bronchiectasis
- Lung cancer
- Interstitial lung disease
- Chronic obstructive pulmonary disease (COPD)
- Congestive heart failure
Crackles can be heard in both phases of breathing – inspiration and expiration. The timing and location of the crackles can help identify the underlying cause:
- Crackles only on inspiration suggest conditions that cause narrowing or blockage of the airways such as asthma, bronchitis, and COPD.
- Crackles on both inspiration and expiration are typical of interstitial lung disease, congestive heart failure, and lung edema.
- Crackles that start at the lung bases and progress upwards over time often indicate fluid accumulation in the lungs.
How can coughing help clear crackles?
Coughing helps clear secretions from the lungs and opens up the airways. As such, it can potentially help clear crackles from the lungs in some situations. Here’s how coughing might help:
- Opens up collapsed airways: In conditions like asthma, bronchitis, and COPD, increased mucus production and bronchospasm can block the airways causing them to collapse. Coughing provides a sudden burst of air that can open up these airways and help clear crackles.
- Mobilizes mucus: In mucus-producing lung conditions like pneumonia, bronchiectasis, and chronic bronchitis, copious amounts of thickened mucus can obstruct the airways and cause crackles. Coughing can help loosen and expel this sticky mucus.
- Improves atelectasis: Atelectasis refers to collapse of lung tissue, which can occur when thick secretions block an airway and prevent air from entering. By re-inflating the collapsed alveoli, coughing may help resolve the atelectasis and related crackles.
- Helps clear edema fluid: In pulmonary edema from heart failure, fluid leaks into the lung alveoli producing crackles. Coughing can shift some of this fluid from the alveoli into the larger airways where it can be coughed out.
However, coughing may not help clear crackles in all cases. Crackles related to interstitial lung disease, lung cancer, and fibrosis deep in the lung tissue are less likely to be mobilized by coughing alone. Overall, coughing is more likely to clear crackles from the large airways rather than the peripheral lung fields.
How to use coughing to clear crackles
If your doctor determines that your crackles are likely due to secretions or bronchospasm, they may recommend coughing exercises to help clear the crackles. Here are some tips:
- Take slow deep breaths to maximally expand the airways before coughing.
- Use the huff cough method – breathe in halfway, then forcefully breathe out. This helps mobilize mucus.
- Try coughing while lying in different positions – on your back, sides, and stomach. Gravity helps drain different lung segments.
- Drink plenty of fluids to thin out mucus secretions.
- Use a humidifier to moisten and loosen sticky mucus.
- Don’t suppress the urge to cough – coughing helps clear irritants from the lungs.
- Avoid smoke, allergens, pollutants, and respiratory irritants.
- Use medications like bronchodilators and mucolytics if prescribed.
Performing chest physiotherapy can also help clear crackles by dislodging mucus through postural drainage, vibration, and percussion. A respiratory therapist can guide you through appropriate physiotherapy techniques.
When to see a doctor
See your doctor if:
- Crackles persist after 2 weeks of coughing and medical treatment
- Crackles are accompanied by worsening shortness of breath or wheezing
- You cough up blood-tinged mucus
- You have lung disease and notice new crackles
- Crackles occur with chest pain, fever, night sweats, or weight loss
Evaluation of persistent crackles generally involves:
- Medical history and physical exam
- Chest x-ray
- CT scan of the chest
- Lung function tests such as spirometry
- Pulse oximetry to measure oxygen levels
- Sputum culture
- Blood tests
Based on the underlying cause, your doctor may prescribe medications like bronchodilators, inhaled steroids, antibiotics, diuretics, or chemotherapy. Oxygen therapy, lung rehabilitation, or surgery may be required in some cases.
Home remedies for crackles
Some home remedies may help manage crackles in addition to medical treatment:
- Steam inhalation: Inhaling warm moist air loosens mucus and helps clear airways. Add menthol or eucalyptus oil to enhance the benefits.
- Chest percussion: Clapping on the chest walls loosens mucus that can then be coughed out. Do this before physiotherapy.
- Prone positioning: Lying flat on your stomach helps drain mucus from posterior lung segments.
- Pursed lip breathing: Breathing out slowly through pursed lips helps keep airways open. This is helpful for COPD.
- Yoga and deep breathing: Pranayama breathing techniques maximize expansion of lung tissue.
- Fluids and hydration: Drink lots of fluids, especially warm fluids, to thin out mucus.
- Pepper and turmeric: The compounds in these spices help loosen mucus.
- Ginger and garlic: Have antioxidant, anti-inflammatory, and antimicrobial benefits in lung conditions.
- Licorice root: Soothes airway inflammation and relieves coughing and throat irritation.
Lifestyle changes for chronic crackles
Making certain lifestyle changes can help prevent recurrence of crackles in chronic lung conditions like asthma, COPD, and bronchiectasis:
- Avoid smoke, dust, fumes, and other lung irritants.
- Use air filters and purifiers at home.
- Get vaccinated against flu and pneumonia.
- Manage heart disease, GERD, and allergies.
- Maintain a healthy weight.
- Exercise regularly to expand and strengthen lung capacity.
- Do breathing exercises like diaphragmatic breathing, pursed lip breathing.
- Add antioxidants like Vitamin C and carotenoids to your diet.
- Stay well hydrated.
- Use bronchodilators or corticosteroids as prescribed.
- Get regular health screening.
When to see a doctor for chronic crackles
Consult your doctor if you have recurrent crackles along with:
- Progressive shortness of breath
- Chronic productive cough
- Blood in mucus
- Wheezing or chest tightness
- Fever, chills, night sweats
- Unexplained weight loss
- Leg swelling
Routine health maintenance for chronic lung conditions involves:
- Monitoring crackles, oxygen levels, and lung function
- Chest x-rays to assess lung changes
- Sputum analysis when required
- Seasonal flu and pneumonia vaccines
- Checking for side effects of medications
Early evaluation of recurrent crackles allows treatment to be optimized and prevents serious complications.
Conclusion
Coughing can potentially help clear crackles from the lungs by opening up collapsed airways, mobilizing mucus secretions, improving areas of atelectasis, and clearing pulmonary edema fluid. However, deep-seated crackles may not be affected by coughing alone. Performing coughing exercises, chest physiotherapy, and using mucolytic agents can enhance the clearance of crackles. Along with appropriate medical treatment, certain lifestyle measures can help prevent recurrence of chronic crackles. Persistent or worsening crackles should be evaluated promptly to identify and treat the underlying lung condition.