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Age-Related Pulmonary Crackles (Rales) in Asymptomatic Cardiovascular Patients

¹ Division of Internal Medicine, Nishida Hospital, Oita, Japan
² Division of Respiratory Disease, Oita University Hospital, Oita, Japan Conflicts of interest: none reported

CORRESPONDING AUTHOR: Hajime Kataoka, MD, 3-3-24 Ohte-machi, Saiki-city, Oita 876-0831, Japan, hkata{at}cream.plala.or.jp

PURPOSE The presence of age-related pulmonary crackles (rales) might interfere with a physician’s clinical management of patients with suspected heart failure. We examined the characteristics of pulmonary crackles among patients with stage A cardiovascular disease (American College of Cardiology/American Heart Association heart failure staging criteria), stratiffed by decade, because little is known about these issues in such patients at high risk for congestive heart failure who have no structural heart disease or acute heart failure symptoms.

METHODS After exclusion of comorbid pulmonary and other critical diseases, 274 participants, in whom the heart was structurally (based on Doppler echocardiography) and functionally (B-type natriuretic peptide <80 pg/mL) normal and the lung (X-ray evaluation) was normal, were eligible for the analysis.

RESULTS There was a significant difference in the prevalence of crackles among patients in the low (45–64 years; n = 97; 11%; 95% CI, 5%–18%), medium (65–79 years; n = 121; 34%; 95% CI, 27%–40%), and high (80–95 years; n = 56; 70%; 95% CI, 58%–82%) age-groups (P <.001). The risk for audible crackles increased approximately threefold every 10 years after 45 years of age. During a mean follow-up of 11 ± 2.3 months (n = 255), the short-term (3 months) reproducibility of crackles was 87%. The occurrence of cardiopulmonary disease during follow-up included cardiovascular disease in 5 patients and pulmonary disease in 6.

CONCLUSIONS Recognition of age-related pulmonary crackles (rales) is important because such clinically unimportant crackles are so common among elderly patients that, without knowledge of this phenomenon, their existence might interfere with the physician’s management of cardiopulmonary patients.

Key Words: Physical examination • auscultation • crackles • respiratory sounds • rales • aging • heart failure

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