A wheeze is a clinical symptom of a continuous, coarse, whistling sound produced in the respiratory airways during breathing.[1] For wheezes to occur, part of the respiratory tree must be narrowed or obstructed (for example narrowing of the lower respiratory tract in an asthmatic attack), or airflow velocity within the respiratory tree must be heightened. Wheezing is commonly experienced by persons with a lung disease; the most common cause of recurrent wheezing is asthma, though it can also be a symptom of lung cancer, congestive heart failure, and certain types of heart diseases.
| Wheezing | |
|---|---|
| Other names | Sibilant rhonchi |
| The sound of wheezing as heard with a stethoscope | |
| Specialty | Pulmonology |
| Causes | virus, bacteria, common cold, allergy, pneumonia, asthma, tuberculosis |
The differential diagnosis of wheezing is wide, and the reason for wheezing in a given patient is determined by considering the characteristics of the wheezes and the historical and clinical findings made by the examining physician.
The term "wheeze" is also used as a clinical condition describing wheezing in preschool children, termed as "preschool wheeze".[2]
Clinical symptom
editWheeze
editWheezes occupy different portions of the respiratory cycle depending on the site of airway obstruction and its nature. The fraction of the respiratory cycle during which a wheeze is produced roughly corresponds to the degree of airway obstruction.[3][4] Bronchiolar disease usually causes wheezing that occurs in the expiratory phase of respiration. As a rule, extrathoracic airway obstruction produce inspiratory sounds. Intrathoracic major airway obstruction produces inspiratory as well as expiratory sounds. Distal airway obstruction predominantly produces expiratory sounds.[5]
The presence of expiratory phase wheezing signifies that the patient's peak expiratory flow rate is less than 50% of normal.[6] Wheezing heard in the inspiratory phase, on the other hand, is often a sign of a stiff stenosis, usually caused by tumors, foreign bodies or scarring. This is especially true if the wheeze is monotonal, occurs throughout the inspiratory phase (i.e. is "holoinspiratory"), and is heard more proximally, in the trachea. Inspiratory wheezing also occurs in hypersensitivity pneumonitis.[7] Wheezes heard at the end of both expiratory and inspiratory phases usually signify the periodic opening of deflated alveoli, as occurs in some diseases that lead to collapse of parts of the lungs.
The location of the wheeze can also be an important clue to the diagnosis. Diffuse processes that affect most parts of the lungs are more likely to produce wheezing that may be heard throughout the chest via a stethoscope. Localized processes, such as the occlusion of a portion of the respiratory tree, are more likely to produce wheezing at that location, hence the sound will be loudest and radiate outwardly. The pitch of a wheeze does not reliably predict the degree of narrowing in the affected airway.[8]
Stridor
editA special type of wheeze is stridor. Stridor — the word is from the Latin, strīdor[9] — is a harsh, high-pitched, vibrating sound that is heard in respiratory tract obstruction. Stridor heard solely in the inspiratory phase of respiration usually indicates an upper respiratory tract obstruction, "as with aspiration of a foreign body (such as the fabled pediatric peanut)."[10] Stridor in the inspiratory phase is usually heard with obstruction in the upper airways, such as the trachea, epiglottis, or larynx; because a block here means that no air may reach either lung, this condition is a medical emergency. Biphasic stridor (occurring during both the inspiratory and expiratory phases) indicates narrowing at the level of the glottis or subglottis, the point between the upper and lower airways.
Preschool wheeze
editPreschool wheezing is a clinical condition that describes wheezing preschool children that do not fulfill the criteria of "asthma" fully as asthma would require a person to demonstrate a history of at least three episodes of exacerbations (worsening of symptoms) or chronic cough or wheeze for the past six months.[2] Besides, a number of wheezing preschool children would have their symptoms resolved after they had grown up, unlike asthma which persists into adulthood. Preschool wheezing can be divided into "viral-induced wheeze" and "multi-trigger wheeze". Viral-induced wheezing accounts for about two-thirds of all preschool wheezes. The wheezing symptom is episodic and the child is completely normal in between wheezing episodes. It has a good prognosis and only supportive treatment is required. Meanwhile, multi-trigger wheezing is associated with allergy and a family history of asthma. Symptoms occur in between wheezing episodes and are likely to persist beyond early childhood. Due to difficulty in differentiating both types of wheeze, the diagnosis of viral-induced versus multi-trigger wheeze may be delayed for a period of time until its clinical course has become clear.[2]
To wheeze (slang)
editTo wheeze implies an inability to speak clearly, so in politics it refers to an unorthodox or less than ethical maneuver that is not actually illegal, but relies on an element of deception or sleight of hand, being an intermediate between a workaround and a scam[11]
In this context wheezing is notably linked with the slang expression Joe Blow meaning any external person or group beyond a secretive fraternity [12] (See also insider trading)
See also
edit- Crackles (also called "crepitations" or "rales")
- Rhonchi
- Squawk (sound)
References
edit- ^ Sengupta N, Sahidullah M, Saha G (August 2016). "Lung sound classification using cepstral-based statistical features". Computers in Biology and Medicine. 75 (1): 118–129. doi:10.1016/j.compbiomed.2016.05.013. PMID 27286184.
- ^ a b c Van Bever HP, Han E, Shek L, Yi Chng S, Goh D (November 2010). "An approach to preschool wheezing: to label as asthma?". The World Allergy Organization Journal. 3 (11): 253–257. doi:10.1097/WOX.0b013e3181fc7fa1. PMC 3651058. PMID 23282943.
- ^ Baughman RP, Loudon RG (November 1984). "Quantitation of wheezing in acute asthma". Chest. 86 (5): 718–722. doi:10.1378/chest.86.5.718. PMID 6488909.
- ^ Pasterkamp H, Tal A, Leahy F, Fenton R, Chernick V (July 1985). "The effect of anticholinergic treatment on postexertional wheezing in asthma studied by phonopneumography and spirometry". The American Review of Respiratory Disease. 132 (1): 16–21. doi:10.1164/arrd.1985.132.1.16 (inactive 1 November 2024). PMID 3160273.
{{cite journal}}: CS1 maint: DOI inactive as of November 2024 (link) - ^ Ghai, OP (2014). Essential Pediatrics. CBS Publishers & Distributors. p. 372. ISBN 978-81-239-2334-5.
- ^ Shim CS, Williams MH (May 1983). "Relationship of wheezing to the severity of obstruction in asthma". Archives of Internal Medicine. 143 (5): 890–892. doi:10.1001/archinte.143.5.890. PMID 6679232.
- ^ Earis JE, Marsh K, Pearson MG, Ogilvie CM (December 1982). "The inspiratory "squawk" in extrinsic allergic alveolitis and other pulmonary fibroses". Thorax. 37 (12): 923–926. doi:10.1136/thx.37.12.923. PMC 459459. PMID 7170682.
- ^ Meslier N, Charbonneau G, Racineux JL (November 1995). "Wheezes". The European Respiratory Journal. 8 (11): 1942–1948. doi:10.1183/09031936.95.08111942. PMID 8620967.
- ^ Simpson JA, Weiner ESC (eds). "stridor, n. 2." Oxford English Dictionary 2nd ed. Oxford: Clarendon Press, 1989. OED Online Oxford University Press. Accessed September 10, 2005. http://dictionary.oed.com Archived 2006-06-25 at the Wayback Machine.
- ^ Sapira JD, Orient JM (2000). Sapira's art & science of bedside diagnosis (2nd ed.). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 978-0-683-30714-6.
- ^ Word Reference Wheeze Accessed 02 July 2024
- ^ Vocabulary.com: Joe Blow Accessed 02 July 2024
Further reading
editExternal links
edit- Audio Breath Sounds Archived 2020-12-15 at the Wayback Machine - Multiple case studies with audio files of lung sounds.
- R.A.L.E. Repository - sound files of breath sounds