Wheezing

Wheezing is often described as a whistling or squeaking noise that occurs when people breathe. When the airways are narrowed from any cause, the air passing through them may make the noise known as wheezing. Wheezing usually occurs when a person breathes out, or exhales, but may also occur when a person breathes in, or inhales. There are many possible causes.

If someone complains of wheezing, the healthcare professional will need more information. Questions that may be asked include:

• when the wheezing started
• whether there is any family history of wheezing
• whether the wheezing is constant or comes and goes
• what medications, herbs, or illegal drugs a person takes, if any
• whether or not the person has been exposed to any substances that may irritate the lungs, such as tobacco smoke or industrial chemicals
• what other medical conditions a person has, especially heart and lung conditions
• if anything makes the wheezing better or worse, such as staying inside or being around cats, or exercise
• any other symptoms, such as fever, weight loss, or cough

Sometimes a healthcare professional can hear wheezing through a stethoscope during a physical exam when the person him- or herself has not complained of it or even noticed it.

Wheezing has many possible causes, including:

• asthma, a condition that causes reversible narrowing of the airways. This usually occurs after exposure to certain triggers, such as pollen, cold air, or exercise.
• chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. This is usually due to smoking cigarettes.
• heart conditions, such as congestive heart failure or mitral stenosis, a disorder that affects one of the valves of the heart
• a tumor in the lung, particularly primary lung cancer
• heartburn, also called gastroesophageal reflux disease
• allergic reactions, which may be from medications such as penicillin or aspirin, or due to exposure to cat dander, bee stings, a certain food, or some other substance
• infections, such as pneumonia, or a viral infection usually seen in children called bronchiolitis
• a foreign body somewhere in the windpipes. This commonly occurs in young children who can accidentally inhale small objects they put into their mouths.
• cystic fibrosis, an inherited condition that mainly affects the lungs and digestion
• inflammation of the lung from other conditions, such as a disorder known as sarcoidosis

Other causes are also possible. Sometimes no cause can be found.

Prevention is related to the cause. For instance, avoiding smoking can help prevent most cases due to emphysema or lung cancer. Keeping small objects away from young children can prevent some cases due to a foreign body. Medicines can be used to help prevent wheezing when asthma is the cause. Many cases cannot be prevented.

Sometimes the cause of wheezing is obvious from the medical history and physical exam. In other cases, further tests may be needed, depending on the suspected cause. For instance, a type of breathing test called pulmonary function testing can help diagnose asthma and COPD. Chest x-rays can help detect pneumonia, sarcoidosis, and other conditions. Special x-ray tests, such as a chest CT scan, may be needed in certain cases. For instance, a CT scan can help detect lung cancer.

Wheezing is a symptom of a breathing problem. Those with severe narrowing in multiple areas of their airways may die if they cannot take in enough air. Other long-term effects are related to the cause. For instance, cancer can result in death even if the wheezing stops.

Wheezing itself is not contagious. But if the cause is an infection, such as pneumonia, the infection may be contagious.

Sometimes the cause of wheezing is obvious from the medical history and physical exam. In other cases, further tests may be needed, depending on the suspected cause. For instance, a type of breathing test called pulmonary function testing can help diagnose asthma and COPD. Chest x-rays can help detect pneumonia, sarcoidosis, and other conditions. Special x-ray tests, such as a chest CT scan, may be needed in certain cases. For instance, a CT scan can help detect lung cancer.

Treatment is then directed at the cause, when possible. For instance, antibiotics can be used to treat pneumonia. Medications can be used to control heartburn. Medications to reduce inflammation are often helpful in asthma, sarcoidosis, and COPD. Surgery, chemotherapy, or radiation therapy may be needed to treat a tumor or cancer.

Side effects depend on the treatments used. All medications have possible side effects. For instance, antibiotics may cause allergic reactions, stomach upset, or headache. A ventilator may cause damage to the lungs or cause a lung infection. Surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.

Severe wheezing from almost any cause may result in death if treatment is unsuccessful. What happens after treatment otherwise depends on the cause. Some cases of wheezing, such as those caused by pneumonia or heartburn, are usually cured after treatment of the cause.

A person with moderate or severe wheezing is often admitted to the hospital for close monitoring. A person with mild wheezing may be given treatments to use at home. Any worsening of symptoms should be reported to the healthcare professional immediately. Other monitoring is related to the cause. For instance, a person with lung cancer may need repeated x-ray tests to follow the tumor and its response to treatment.