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ULY CLINIC

20 Septemba 2025, 04:14:45

Wheezing

Wheezes are high-pitched, musical, squealing, creaking, or groaning adventitious breath sounds caused by airflow at high velocity through narrowed airways. When originating in large airways, they may be heard by placing an unaided ear over the chest wall or at the mouth. Small airway wheezes are detected with a stethoscope on the anterior or posterior chest. Unlike crackles or rhonchi, wheezes cannot be cleared by coughing.

Prolonged wheezing is usually expiratory, as bronchi shorten and narrow. Inspiratory wheezing often indicates severe airway obstruction. Causes of airway narrowing include bronchospasm, mucosal edema, partial obstruction (tumor, foreign body, secretions), or extrinsic compression (e.g., goiter, tension pneumothorax).

Emergency interventions

Assess respiratory distress: responsiveness, restlessness, anxiety, irregular breathing.
Evaluate for accessory muscle use, chest retractions, stridor, nasal flaring.
Check vital signs, noting hypotension, hypertension, oxygen saturation, and pulse abnormalities.
Provide humidified oxygen and encourage slow, deep breaths.
Prepare emergency equipment, including endotracheal intubation and resuscitation supplies.
Call respiratory therapy for nebulization with bronchodilators and intermittent positive pressure breathing.
Insert an IV line for administration of steroids, bronchodilators, diuretics, or sedatives.
For foreign body obstruction, perform abdominal thrusts as indicated.

History and Physical Examination

Determine triggers, history of asthma or allergies, smoking, pulmonary or cardiac disease, cancer, or prior surgery/trauma.
Assess appetite, weight changes, exercise tolerance, and sleep patterns.
Obtain drug and exposure history (toxins, irritants).
Characterize cough: dry, productive, bloody, paroxysmal, timing, and triggers.
Evaluate chest pain: quality, onset, duration, radiation, and relation to breathing/coughing.
Examine nose and mouth for congestion, infection, or halitosis; collect sputum if produced.
Assess cyanosis, pallor, masses, swelling, jugular distension, lymphadenopathy.
Inspect chest configuration and tracheal position; percuss for dullness or hyperresonance.
Auscultate for adventitious sounds (crackles, rhonchi, wheezes, pleural rubs).
Evaluate heart sounds and note arrhythmias.

Medical causes

Cause	Onset	Key Features	Associated Findings	Pathophysiology	Management
Asthma	Acute/Chronic	Wheezing, prolonged expiration	Dry cough initially, later productive; dyspnea, accessory muscle use	Airway inflammation, bronchospasm, mucus buildup	Bronchodilators, corticosteroids, oxygen therapy, avoid triggers
Anaphylaxis	Acute	Wheezing, stridor	Urticaria, angioedema, hypotension, dyspnea, nasal pruritus	IgE-mediated systemic allergic reaction	Epinephrine, oxygen, antihistamines, corticosteroids, airway support
Aspiration of foreign body	Acute	Sudden onset wheezing	Dry cough, gagging, hoarseness, cyanosis	Mechanical airway obstruction	Remove foreign body, oxygen, bronchodilators, airway support
Aspiration pneumonitis	Acute	Wheezing, tachypnea	Cyanosis, dyspnea, cough (purulent), fever	Inflammatory response to aspirated material	Oxygen, antibiotics if infection, supportive care
Bronchial adenoma	Gradual	Localized wheezing	Chronic cough, hemoptysis	Airway obstruction by tumor	Surgical excision, bronchoscopy, follow-up
Bronchiectasis	Gradual	Intermittent/diffuse wheezing	Foul-smelling productive cough, hemoptysis, clubbing, fatigue	Chronic airway dilation and mucus accumulation	Antibiotics, airway clearance, bronchodilators, physiotherapy
Chronic bronchitis	Gradual	Wheezing varies with severity/location	Productive cough, dyspnea, accessory muscle use, cyanosis	Chronic airway inflammation and mucus hypersecretion	Bronchodilators, corticosteroids, oxygen, smoking cessation
Bronchogenic carcinoma	Gradual	Localized wheezing	Cough, hemoptysis, weight loss, chest pain, dyspnea	Airway obstruction by tumor	Surgical excision, chemotherapy, radiotherapy
Emphysema	Gradual	Mild to moderate wheezing	Dyspnea, barrel chest, diminished breath sounds, peripheral cyanosis	Loss of alveolar elasticity, airway collapse	Bronchodilators, oxygen, pulmonary rehab, smoking cessation
Pulmonary coccidioidomycosis	Gradual/Acute	Wheezing, rhonchi	Fever, chills, pleuritic chest pain, cough	Fungal infection causing airway inflammation	Antifungals (fluconazole, itraconazole), supportive care
Pulmonary edema	Acute	Wheezing, crackles	Dyspnea, orthopnea, frothy sputum, tachypnea, hypotension	Fluid accumulation in alveoli	Oxygen, diuretics, treat underlying cause (heart failure)
RSV bronchiolitis	Acute (children)	Wheezing, tachypnea	Apnea, nasal flaring, fever, cough, chest retractions	Viral infection causing small airway obstruction	Supportive care, oxygen, hydration, monitor for complications
Tracheobronchitis	Acute	Wheezing, rhonchi	Cough, mild fever, substernal tightness	Inflammation of trachea/bronchi	Supportive care, hydration, bronchodilators if needed
Blast lung injury	Acute	Wheezing, dyspnea	Hemoptysis, hypoxia, cyanosis, tachypnea	Blast-induced lung tissue injury	Oxygen, airway support, treat chemical/physical injuries
Wegener’s granulomatosis	Gradual	Mild to moderate wheezing	Cough (sometimes bloody), pleuritic pain, renal failure, hemorrhagic lesions	Granulomatous inflammation causing airway narrowing	Immunosuppressants, corticosteroids, treat systemic involvement

Special considerations

Perform diagnostic tests: chest X-ray, arterial blood gas, pulmonary function tests, sputum culture.
Positioning: semi-Fowler’s; reposition frequently.
Pulmonary physiotherapy as needed.
Medications: antibiotics, bronchodilators, steroids, mucolytics/expectorants.
Provide humidified oxygen to thin secretions.

Patient counseling

Educate about prescribed medications and their purpose.
Explain techniques for deep breathing and effective coughing.
Encourage hydration to facilitate secretion drainage.

Pediatric pointers

Children have smaller airways, making them more susceptible to obstruction and wheezing.
Common causes: bronchospasm, mucosal edema, secretion accumulation.
Disorders include cystic fibrosis, foreign body aspiration, bronchiolitis, pulmonary hemosiderosis.

References

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Colyar MR. Well-Child Assessment for Primary Care Providers. Philadelphia (PA): F.A. Davis; 2003.
McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Maryland Heights (MO): Mosby Elsevier; 2010.
Sommers MS, Brunner LS. Pocket Diseases. Philadelphia (PA): F.A. Davis; 2012.
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2025 Update. [Internet] Available from: https://ginasthma.org/2025-report
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