Makindo Medical Notes.com

Wheeze is a high-pitched whistling sound produced during breathing, typically caused by airflow obstruction or narrowing of the airways. It is often heard during exhalation but can also occur during inhalation in severe cases.

Causes of Wheeze

• Asthma: A chronic inflammatory disorder of the airways causing reversible airway obstruction.
• Chronic Obstructive Pulmonary Disease (COPD): Progressive airflow limitation due to chronic bronchitis or emphysema.
• Bronchiolitis: Inflammation of the small airways, commonly seen in infants due to viral infections.
• Anaphylaxis: A severe allergic reaction causing airway constriction and wheezing.
• Foreign Body Aspiration: Obstruction of the airway by an inhaled object, leading to wheezing and respiratory distress.
• Heart Failure (Cardiac Asthma): Pulmonary congestion causing wheezing, particularly in left-sided heart failure.
• Infections: Respiratory tract infections, such as bronchitis or pneumonia, can cause wheezing due to inflammation and mucus production.
• Gastr oesophageal Reflux Disease (GERD): Acid reflux can irritate the airways and lead to wheezing, especially in children.
• Vocal Cord Dysfunction: Abnormal movement of the vocal cords during breathing, causing wheezing.
• Bronchiectasis: Chronic dilation and damage to the bronchi, leading to recurrent infections and wheezing.

Clinical Features

• High-pitched whistling sound during breathing
• Shortness of breath
• Chest tightness
• Coughing, particularly at night or early morning
• Difficulty exhaling completely
• Use of accessory muscles for breathing in severe cases
• Associated symptoms may include fever, productive cough, and cyanosis depending on the underlying cause.

Diagnosis

• History and Physical Examination: Identifying the presence of wheeze, associated symptoms, and potential triggers (e.g., allergens, infections).
• Spirometry: Measures lung function and airflow obstruction, useful in diagnosing asthma and COPD.
• Chest X-ray: Helps identify infections, foreign bodies, or lung pathology causing wheezing.
• Blood Tests: Can help identify signs of infection or inflammation.
• Peak Expiratory Flow (PEF): Can assess the severity of airway obstruction in conditions like asthma.
• Allergy Testing: If allergies are suspected, skin tests or blood tests for allergens may be performed.
• CT Scan: May be indicated in cases of chronic wheeze to evaluate underlying lung diseases such as bronchiectasis.

Initial Management

• Oxygen Therapy: Administer supplemental oxygen in cases of hypoxia or severe respiratory distress.
• Inhaled Bronchodilators: Short-acting beta-agonists (e.g., salbutamol) are the mainstay of treatment to relieve bronchospasm and improve airflow.
• Systemic Corticosteroids: Oral or intravenous steroids (e.g., prednisone) to reduce airway inflammation in asthma exacerbations or severe COPD.
• Antibiotics: Used if bacterial infections such as pneumonia or bronchitis are suspected.
• Removal of Foreign Body: In cases of foreign body aspiration, bronchoscopy may be necessary to remove the object.
• Adrenaline (Epinephrine): Administer in cases of anaphylaxis to reverse airway constriction and treat life-threatening allergic reactions.

Chronic Management

• Long-term Inhaled Corticosteroids (ICS): Used in asthma or COPD to control chronic inflammation and prevent exacerbations.
• Long-acting Beta-agonists (LABA): In combination with ICS, LABA medications (e.g., salmeterol) help maintain long-term control of asthma or COPD.
• Anticholinergics: Used in COPD to relax airway muscles and reduce bronchoconstriction.
• Management of Triggers: Identify and avoid triggers such as allergens, smoking, or GERD in patients with recurrent wheezing.
• Vaccination: Annual influenza and pneumococcal vaccines are recommended for patients with asthma, COPD, and other chronic respiratory conditions.

When to Refer

• Severe or refractory wheezing that does not respond to initial treatment
• Suspected foreign body aspiration or structural airway abnormalities
• Chronic wheeze with unclear etiology requiring specialist evaluation (e.g., pulmonologist, allergist)