Wheezing

Wheezing refers to the peculiar whistling sound produced when breathing through narrow airways. The sound usually occurs during exhalation, but in severe cases, it can happen during inhalation as well.

The sound is produced by turbulent airflow through a compressed air tube that causes vibration of the walls. It may be a sign of breathing problems. The most common causes of wheezing and narrowing of airways are asthma and chronic obstructive pulmonary disease (COPD), so if you  suffer from wheezing, have it looked at right away by a specialist.

It may also be caused by bronchoconstriction, mucosal edema, or partial obstruction of airways by a tumor, foreign body, or thick secretions within the tube. Wheezing during expiration is an indication of a mild obstruction in the airways, while wheezing during both inhalation and exhalation indicates a more severe condition. The moment you start experiencing something similar, head to the emergency room right away and get a checkup. Other disorders may also affect the airways, including heart failure, anaphylaxis, and toxic inhalation. Acute bronchitis is implicated in wheezing in some patients. Certain medications, including ACE inhibitors, beta-blockers, and nonsteroidal anti-inflammatory drugs, may also lead to wheezing. Your doctor may ask for your detailed medical history, so it is essential that you are totally upfront about it. Your doctor will discuss the various conditions that could be causing the wheezing and may ask about any medications you are taking at the moment, as well as whether or not you are allergic to any. They will then run tests to determine the cause behind your wheezing and recommend treatment, ranging from mild to aggressive.

In children, aspiration of foreign bodies causes narrowing of the airways and thus wheezing. Chronic aspiration of refluxed material due to gastroesophageal reflux disease (GERD) can lead to recurrent wheezing, often associated with heartburn and nocturnal cough. Vocal cord dysfunction, sleep apnea, pneumonia, and reaction to smoking are other possible causes.

Certain factors increase the risk of wheezing, including:

• Family history of asthma: If you have a family history of asthma, chances are high that you may have it. This is why it is important to meet up with your doctor so they can recommend effective treatment upon diagnosing your condition.
• Allergies: You may have developed an allergy to some substance, which is now causing wheezing. Ask your doctor to run a full-panel allergy test to discover the various allergens you are allergic to. Developing allergic symptoms can also put you at risk of acquiring a chronic wheezing problem.
• Smoking or history of smoking: If you have a history of smoking or smoke a good deal each day, this puts you at risk of developing wheezing. It is important that you quit this habit at the earliest before you end up suffering from a chronic condition or worse.

Leaving children in day care is a risk factor for them developing this condition. Warning signals that call for immediate medical attention are difficulty breathing, bluish skin, altered mental state, swollen face, and swollen throat. Make sure you head over to the emergency room the moment you spot your child displaying any of these symptoms. Consult a pediatrician at the earliest to ensure your child is treated for this condition right away, before it gets any worse.

Diagnosis of the underlying cause of wheezing includes evaluation of the present illness, review of symptoms, and analysis of medical history. Be upfront with your doctor about it, as well as any allergies, as these could have caused the wheezing in the first place. Make sure you are able to correctly explain when the symptoms first showed up, and allow your doctor to run tests so they can diagnose your condition correctly, after which a course of treatment will be recommended.

During the physical examination, vital signs are measured to check for changes in heart rate and oxygen saturation. Signs of respiratory distress are also noted. Some tests used to confirm a diagnosis are pulse oximetry, chest x-ray, and pulmonary function testing. Moreover, your doctor may ask about your habits, such as whether or not you smoke. This can have a bearing on your current condition and, if you do not quit right away, can further exacerbate it.

Treatment focuses on reducing inflammation of the airways and opening them up for easy passage of air. Anti-inflammatory medications help in this endeavor. They are available in the form of oral tablets, syrups, or inhalers. Your doctor will attempt to reduce the inflammation with one of these, after which, if this fails, a different course of treatment will be recommended.

Bronchodilators help dilate the airways and thus reduce wheezing and cough. These medications relax the muscles of the airways, opening them up for easy movement of air. For wheezing caused by chronic conditions like asthma and COPD, both bronchodilators and anti-inflammatory medications are recommended. This should enable you to breathe more easily as the medications cause your airways to relax.

Simple home remedies like keeping the room humid and warm help open up the airways. Alternative remedies, like herbal supplements, are also used for controlling wheezing. Homemade remedies can be effective as long as the condition is not serious, but you should still seek out medical attention right away to ensure your condition is diagnosed correctly; do not depend on homemade remedies alone to treat it.

Yoga, meditation, and antioxidants are also used to control the condition. If left untreated, wheezing may lead to complications like breathlessness and altered mental state, so make sure you seek out treatment right away.

Treatment for wheezing depends on its actual cause. Long-term treatment is recommended for chronic conditions like asthma and COPD. Wheezing caused by infections and other diseases may be resolved as the underlying condition is treated. For recurring wheezing, more aggressive treatment may be needed. This is why it is vital that you seek medical help at the earliest, as a fast diagnosis can enable you to get treated for your wheezing and lead to faster recovery.

Narrowing of airways causes turbulence in the airflow, resulting in wheezing. As the airway is compressed, the walls vibrate and produce the sound. The sound is more pronounced during exhalation as the tube is narrower due to the increase in intrathoracic pressure.

Airways may be constricted by bronchoconstriction, mucosal edema, thick secretions within the airways, or the presence of a tumor, but the most common causes of airway narrowing are asthma and COPD. Your doctor will run a few tests to confirm this and then advise you on the implications behind the condition and the lifestyle changes you need to adopt in order to better manage. The doctor will also recommend a course of treatment to provide you with relief, when, for example, an asthma attack takes place.

Some of the causes of wheezing are:

• Acute bronchitis: Inflammation of bronchial branches is known as bronchitis and often follows a respiratory infection. It is usually caused by a viral infection and is characterized by a cough, fever, and wheezing.
• Allergy: Symptoms of an allergic reaction have a sudden onset, often within half an hour of exposure to the allergen. The most common symptoms of an allergic reaction are nasal congestion, itchy eyes, sneezing, and wheezing. Your doctor will make a careful physical inspection in order to spot these telltale signs of an allergy attack. In case of an allergy attack, they will prescribe medication to keep the symptoms down and treat your allergy. The moment it is treated, your wheezing should disappear.
• Asthma: Wheezing, the most common symptom, may arise spontaneously or after exposure to a specific trigger.
• Bronchiolitis: Bronchiolitis is an acute viral infection of the lower respiratory tract. It is seen in infants and is characterized by respiratory difficulties and wheezing.  The condition is treatable, so be sure to seek out medical attention right away.
• COPD: COPD is characterized by inhibition of airflow due to an inflammatory response to toxins like cigarette smoke. Symptoms of COPD include difficulty breathing, productive cough, and wheezing. It is more common among middle-aged and elderly patients. Most patients with it have a history of smoking or are current smokers.
• Certain medications: Some medications are known to cause airway obstruction, leading to wheezing. These include ACE inhibitors, NSAIDs, aspirin, and beta-blockers. The symptom is mostly seen in patients who have recently begun a new drug, so make sure your doctor knows about all medications you are currently taking.
• Tumors: Tumors within the airways can lead to wheezing during both inhalation and exhalation. This is more commonly seen in patients with a high risk of cancer.  Seek medical attention right away so the doctor can check your airways for signs of tumors and run tests to confirm whether you have cancer or not.
• Aspiration of foreign body: Symptoms of wheezing due to aspiration of a foreign body usually occur suddenly, particularly in children who do not have an upper respiratory tract infection. The doctor will run a scan to get an exact idea of the foreign object and, depending on the size and shape, may recommend several therapies, including surgery. With treatment and effective post-operative care, your child’s condition should improve.
• GERD: Aspiration of refluxed particles results in chronic wheezing, often associated with a cough and heartburn. These patients may not have symptoms of an allergy or upper respiratory tract infection.
• Inhalation of irritants: Exposure to irritants may result in the sudden onset of wheezing and other symptoms. This is easily treatable, and with the right medication, you should experience relief and have your condition treated.
• Cardiac failure with pulmonary edema: This condition, also called cardiac asthma, leads to crackles, distension of neck veins, and peripheral edema. It may also lead to difficulty breathing while lying down.  Your doctor will run a few tests to confirm your condition and, with effective treatment, you should be back to normal soon.
• Bronchiectasis: This is a less common cause of wheezing, characterized by abnormal widening of the bronchial tubes. Mucus clearing is inhibited, leading to restricted airflow.

Other causes of wheezing include: 

• Epiglottitis
• Abdominal muscle strain
• Respiratory syncytial virus
• Obstructive sleep apnea
• Vocal cord dysfunction
• Childhood asthma

Risk factors that increase the chances of wheezing include: 

• Family history of asthma
• Allergy
• Cancer
• Smoking

Leaving children in day care is also a risk factor for developing wheezing.

An analysis  of the present condition, review of signs and symptoms, and evaluation of medical history are part of the diagnostic procedure. Evaluating the status of the present condition helps determine whether the symptom is newly onset or recurrent.

Acuity of onset, temporal pattern of the wheezing, exacerbating factors, and factors that improve wheezing are also noted during the evaluation, as are any associated symptoms, including breathlessness, fever, and cough.

Reviewing the signs and symptoms provides important clues regarding the underlying cause of wheezing. For example, fever and sore throat along with wheezing are common in respiratory infections, while peripheral edema and orthopnea are indications of heart failure.

Unexplained weight loss, fatigue, and night sweats are seen in cancer. Nasal congestion, itchy eyes, skin rash, and sneezing are symptoms of an allergic reaction. A history of asthma, COPD, or heart failure, as well as any medications taken, may all indicate conditions that lead to wheezing.

During the physical examination, vital signs are reviewed for fever, changes in heart rate, and oxygen saturation. Signs of respiratory distress are also noted.

During the lung examination, the amount of air entering and leaving the lungs, the symmetry of sounds during breathing, and localization of the wheezing are observed. Features of nasal mucosa like congestion and color, swelling in the face or tongue, and the presence of nasal polyps are checked during nose and throat examinations.

Further tests depend on the underlying cause of the condition. Pulse oximetry is used to assess the severity of respiratory distress. Bedside peak flow measurements are suggested for patients with asthma.

A chest x-ray is suggested for patients who have persistent wheezing, but do not have a history of asthma. Pulmonary function testing is also used for a diagnosis.

Treatment for wheezing depends on the specific cause. Treatment focuses on two important goals:  reducing inflammation of the airways, and opening them up for easier breathing.

Anti-inflammatory medications are used to reduce inflammation and wheezing. Bronchodilators are the choice for opening up the airways and controlling a cough and wheezing. Wheezing caused by asthma is treated with bronchodilator inhalers that help dilate the constricted airways. These include albuterol and levalbuterol. Inhaled corticosteroids like beclomethasone, budesonide, and mometasone are also suggested to control airway inflammation. In some cases, a combination of the two – bronchodilators and corticosteroids – is suggested.

Non-sedative anti-histamine pills, like cetirizine, fexofenadine, and loratadine, and asthma controller pills, like montelukast and zafirlukast, are also helpful in controlling wheezing.

Wheezing may be relieved with inhaled bronchodilators. Wheezing caused by anaphylaxis is treated with intravenous H2 blockers, corticosteroids, and subcutaneous and inhaled epinephrine.

Acute bronchitis is treated with fast-acting bronchodilators like terbutaline or salbutamol. This helps alleviate wheezing and ease breathing until the infection is cleared. The underlying infection is treated with antibiotics.

In case of an emergency where breathing is severely inhibited, intravenous adrenaline is employed. Oxygen supplementation, corticosteroids, mechanical ventilator, and nebulization are also used to bring the condition under control.

Hospitalization is needed if breathlessness becomes severe and intravenous medications are required. In this instance, the patient will be monitored closely by medical personnel. Supplemental oxygen is also possible with a hospital stay.