Wheeze 2558939 215743547 2008-05-29T14:43:49Z TheEgyptian 2285075 [[WP:UNDO|Undid]] revision 214569674 by [[Special:Contributions/61.51.192.12|61.51.192.12]] ([[User talk:61.51.192.12|talk]]) {{SignSymptom infobox | Name = Wheeze | ICD10 = {{ICD10|R|06|2|r|00}} | ICD9 = {{ICD9|786.07}} | }} A '''wheeze''' is a continuous, coarse, whistling sound produced in the respiratory [[airways]] during breathing. For wheezes to occur, some part of the respiratory tree must be narrowed or obstructed, 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]], a form of [[reactive airway disease]]. The [[differential diagnosis]] of wheezing is wide, and the cause of 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 causes of wheezing == [[Image:Asthma before-after.png|thumb|right|470px|'''Inflamed airways and bronchoconstriction in asthma'''. Airways narrowed as a result of the inflammatory response cause wheezing.]] Common causes of wheezing are: *[[Asthma]] *[[Chronic obstructive pulmonary disease]] *Medication-induced bronchoconstriction *[[Pulmonary edema]] *Tracheobronchitis, and *[[Vocal cord]] dysfunction *[[anaphylaxis]] Less common causes of wheezing include: *[[Amyloid]] deposition *[[Carcinoid]] syndrome *[[Chondromalacia]] *Descending [[aortic aneurysm]]s *[[lobectomy|Postlobectomy]] bronchial torsion *Postradiation [[stenosis]] *Tracheo-broncheal tumors *[[Vertebrate trachea|Trachea]]l stenosis *Tracheomalacia *Aspiration (foreign particles or foods) == Characteristics == Wheezes occupy different portions of the [[respiration (physiology)|respiratory]] cycle depending on the site of airway obstruction and its nature. The proportion of the respiratory cycle occupied by the wheeze roughly corresponds to the degree of airway obstruction.{{rf|1|Baughman}}<sup>,</sup>{{rf|2|Pasterkamp}} [[Bronchiole|Bronchiolar]] disease usually causes wheezing that occurs in the expiratory phase of respiration. The presence of expiratory phase wheezing signifies that the patient's [[Spirometry|peak expiratory flow rate]] is less than 50% of normal.{{rf|3|Shim}} Wheezing heard in the inspiratory phase on the other hand is often a sign of a stiff stenosis, usually caused by [[tumor]]s, foreign bodies or scarring. This is especially true if the wheeze is [[monotone|monotonal]], occurs throughout the inspiratory phase (ie. is "holoinspiratory"), and is heard more [[Anatomical position|distally]], in the [[Vertebrate trachea|trachea]]. Inspiratory wheezing also occurs in hypersensitivity pneumonitis.{{rf|4|Earis}} Wheezes heard at the end of both expiratory and inspiratory phases usually signify the periodic opening of deflated [[pulmonary alveolus|alveoli]], as occurs in some diseases that lead to collapse of parts of the [[lung]]s. 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, whence 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.{{rf|5|Meslier}} A special type of wheeze is '''[[stridor]]'''. Stridor — the word is from the Latin, ''strīdor''{{rf|6|OED}} — is a harsh, high-pitched, vibrating sound that is heard in respiratory tract obstruction. Stridor heard solely in the expiratory phase of respiration usually indicates a lower respiratory tract obstruction, "as with aspiration of a foreign body (such as the fabled pediatric peanut)."{{rf|7|Sapira}} 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. == Diagnosis == 1 out of 3 preschool children and 2 out of 3 school children with recurrent wheezing/coughing are [[allergic]].{{Fact|date=May 2008}} Allergy can be described as a malfunction of the human immune system causing a violent reaction against normally harmless substances in our natural environment. The reaction creates an inflammation which, in turn, can lead to a variety of symptoms such as wheezing. Over the last decade allergy has increased rapidly in the Western world.{{Fact|date=May 2008}} Today one child in four is allergic.{[fact}} Early diagnosis of allergy is important for the development of the child later in life.{{Fact|date=May 2008}} There are many patients with symptoms suggesting [[eczema]], [[rhinitis]], [[hay fever]], [[asthma]] or wheezing. Patients with these conditions may have an allergic condition or other diseases. ==See also== * [[Rales]] * [[Rhonchi]] == References == {{ent|1|Baughman}} Baughman RP, Loudon RG. Quantitation of wheezing in acute asthma. ''Chest.'' 1984;86:718–722. PMID 6488909 {{ent|2|Pasterkamp}} Pasterkamp H, Asher T, Leahy F, et al. The effect of anticholinergic treatment on postexertional wheezing in asthma studied by phonopneumography and spirometry. ''Am Rev Respir Dis.'' 1985;132:16–21. PMID 3160273 {{ent|3|Shim}} Shim CS, Williams MH. Relationship of wheezing to the severity of obstruction in asthma. ''Arch Intern Med.'' 1983;143:890–892. PMID 6679232 {{ent|4|Earis}} Earis J, Marsh K, Pearson M, et al. The inspiratory squawk in extrinsic allergic alveolitis and other pulmonary fibrosis. ''Thorax.'' 1982;37:923–926. PMID 7170682 {{ent|5|Meslier}} Meslier N, Charbonneau G, Racineux JL. Wheezes. ''Eur Respir J.'' 1995;8(11):1942-8. PMID 8620967 {{ent|6|OED}} 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. {{ent|7|Sapira}} Orient JM. ''Sapira's Art & Science of Bedside Diagnosis'' 2nd ed. Philadelphia: Lippincott William Wilkins, 2000. ISBN 0-683-30714-2 {{Circulatory and respiratory system symptoms and signs}} [[Category:Medical signs]] [[Category:Abnormal respiration]]