Wheezing

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If you have ever been present while someone is having an asthma attack you have probably heard wheezing. Wheezing is a term that is used to describe a distinctive sound, sometimes described as high or low pitched sound similar to whistling. When wheezing occurs, you can usually hear it when breathing out (exhaling), however you can sometimes also hear it when breathing in (inhaling).

What Causes Wheezing?

Certain conditions cause the small tubes (the bronchi and smaller bronchioles), that carry oxygen to the lungs, to narrow almost to the point of being completely closed.

Resistance as air travels through these partially closed tubes causes the characteristic wheezing sound as an individual struggles to breathe. This is similar to when you have partially clogged water pipes in your home; you can hear the high pitched squealing of water as he rushes past that point.

Wheezing is more common in infants and small children because their airways are naturally smaller. It is estimated that half of the children under the age of six have experienced at least one episode of wheezing.Occasionally wheezing can occur when larger airways become all or partially blocked, or from conditions which affect the vocal cords..

Certain illnesses, infections, conditions (such as choking), and genetics can all play a role in the development of wheezing.

Common Causes of Wheezing

  • anaphylaxis or life threatening allergic reactions - severe allergic reactions to food, insect stings or other substances may cause the airway to swell and cause wheezing. This condition may occur rapidly and also be accompanied by swelling, redness of the face, or hives.
  • GERD - Usually occurs in infants. Wheezing and sometimes coughing usually begins right after feeding. Infants with GERD may have trouble tolerating formula. You should suspect food allergies or lactose intolerance in these cases.
  • asthma - May be exercise induced or caused by allergies. There may be a family history of asthma, allergies or eczema. Asthma related to allergies may only occur at certain seasons of the year.
  • upper respiratory infections - wheezing is usually accompanied by other symptoms.
  • RSV - a viral infection that affects infants and small children leading to wheezing and other breathing problems. Adults may become infected with RSV but symptoms are generally not serious.
  • bronchiolitis & bronchitis
  • pneumonia
  • sleep apnea - in infants, sleep apnea may be caused by abnormalities in facial structure. In small children, sleep apnea may be caused by enlarged tonsils, other ENT disorders or because an individual is overweight.
  • smoking
  • post nasal drip - While post nasal drip itself is a common condition it is unclear how often it leads to wheezing. In one study, 34 patients who were thought to have poorly controlled asthma were actually experiencing wheezing due to post nasal drip syndrome.

Less Common and Rare Causes of Wheezing

  • choking - wheezing can occur if an object is accidentally inhaled and blocks of the airway.
  • congestive heart failure - More common in the elderly or adults with poor health. In infants and small children this usually occurs because the child was born with a congenital heart condition.
  • cystic fibrosis
  • vocal cord dysfunction
  • immunodeficiency disorders
  • tumors or mediastinal masses
  • bronchiolitis obliterans
  • primary ciliary dyskinesia
  • COPD
  • emphysema
  • reactions to medications (particularly aspirin)

Diagnosing Wheezing

Since wheezing is actually a symptom of another disease or condition, the goal in diagnosis is to find the underlying cause. You can expect your doctor to do a thorough physical exam, ask you about any family history of illness, and order other tests based on any findings. Tests your doctor may order include:

Treatment of Wheezing

The treatment your doctor chooses to treat your wheezing depends on the underlying cause of your condition. Choking, or allergic reactions that cause wheezing are emergencies. If you suspect that someone is choking or having this kind of allergic reaction call 911 or take them to the nearest emergency room. In fact, most cases of new onset wheezing require immediate medical treatment since wheezing is a definite sign that someone is having difficulty breathing. Initial treatments may include:

  • oxygen supplementation
  • inhaled medications which dilate the airways
  • other medications (such as epinephrine for allergic reactions)
  • in severe cases endotracheal intubation may be necessary to keep the airway open to support breathing

Once the cause of wheezing has been identified, wheezing can usually be managed with lifestyle changes or medications.

Sources:

American Family Physician. The Diagnosis of Wheezing in Children. Accessed: August 21, 2013 from http://www.aafp.org/afp/2008/0415/p1109.html

Medline Plus. Wheezing. Accessed: August 21, 2013 from http://www.nlm.nih.gov/medlineplus/ency/article/003070.htm

Uptodate. Evaluation of wheezing other than asthma in adults. Accessed: August 21, 2013 from http://www.uptodate.com/contents/evaluation-of-wheezing-illnesses-other-than-asthma-in-adults

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