Wheezing

Information about Wheezing

Name of Symptom/Sign:
**Wheeze**
*Classifications and external resources*
ICD-10	R06.2
ICD-9	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

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 aneurysms
Postlobectomy bronchial torsion
Postradiation stenosis
Tracheo-broncheal tumors
Tracheal stenosis
Tracheomalacia
Aspiration (foreign particles or foods)

Characteristics

Wheezes occupy different portions of the 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.¹^,² Bronchiolar disease usually causes wheezing that occurs in the expiratory phase of respiration. The presence of expiratory phase wheezing signifies that the patient's peak expiratory flow rate is less than 50% of normal.³ 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 (ie. is "holoinspiratory"), and is heard more distally, in the trachea. Inspiratory wheezing also occurs in hypersensitivity pneumonitis.⁴ 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, 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.⁵

A special type of wheeze is stridor. Stridor— the word is from the Latin, strīdor⁶ —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)."⁷ 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.

References

¹ Baughman RP, Loudon RG. Quantitation of wheezing in acute asthma. Chest. 1984;86:718–722. PMID 6488909

² 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

³ Shim CS, Williams MH. Relationship of wheezing to the severity of obstruction in asthma. Arch Intern Med. 1983;143:890–892. PMID 6679232

⁴ 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

⁵ Meslier N, Charbonneau G, Racineux JL. Wheezes. Eur Respir J. 1995;8(11):1942-8. PMID 8620967

⁶ 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. [1]

⁷ Orient JM. Sapira's Art & Science of Bedside Diagnosis 2nd ed. Philadelphia: Lippincott William Wilkins, 2000. ISBN 0-683-30714-2

• • [ e] Symptoms and signs (R00-R69, )
Circulatory and respiratory systems	Tachycardia - Bradycardia - Palpitation - Heart murmur - Nosebleed - Hemoptysis - Cough - abnormalities of breathing (Dyspnea, Orthopnoea, Stridor, Wheeze, Cheyne-Stokes respiration, Hyperventilation, Mouth breathing, Hiccup, Bradypnea, Hypoventilation) - Chest pain - Asphyxia - Pleurisy - Respiratory arrest - Sputum - Bruit
Digestive system and abdomen	Abdominal pain - Acute abdomen - Nausea - Vomiting - Heartburn - Dysphagia - Flatulence - Burping - Fecal incontinence - Encopresis - Hepatomegaly - Splenomegaly - Hepatosplenomegaly - Jaundice - Ascites - Fecal occult blood - Halitosis
Skin and subcutaneous tissue	disturbances of skin sensation (Hypoesthesia, Paresthesia, Hyperesthesia) - Rash - Cyanosis - Pallor - Flushing - Petechia - Desquamation - Induration
Nervous and musculoskeletal systems	abnormal involuntary movements (Tremor, Spasm, Fasciculation, Athetosis) - Gait abnormality - lack of coordination (Ataxia, Dysmetria, Dysdiadochokinesia, Hypotonia) - Tetany - Meningism - Hyperreflexia
Urinary system	Dysuria - Vesical tenesmus - Urinary incontinence - Urinary retention - Oliguria - Polyuria - Nocturia
Cognition, perception, emotional state and behaviour	Anxiety - Somnolence - Coma - Amnesia (Anterograde amnesia, Retrograde amnesia) - Dizziness/Vertigo - smell and taste (Anosmia, Ageusia, Parosmia, Parageusia)
Speech and voice	speech disturbances (Dysphasia, Aphasia, Dysarthria) - symbolic dysfunctions (Dyslexia, Alexia, Agnosia, Apraxia, Acalculia, Agraphia) - voice disturbances (Dysphonia, Aphonia)
General symptoms and signs	Fever (Hyperpyrexia) - Headache - Chronic pain - Malaise - Fatigue - Fainting (Vasovagal syncope) - Febrile seizure - Shock (Cardiogenic shock) - Lymphadenopathy - Edema (Peripheral edema, Anasarca) - Hyperhidrosis (Sleep hyperhidrosis) - Delayed milestone - Failure to thrive - food and fluid intake (Anorexia, Polydipsia, Polyphagia) - Cachexia - Xerostomia - Clubbing

The term symptom (from the Greek σύμπτωμα meaning 'chance', 'mishap' or 'casualty', itself derived from συμπιπτω
..... Click the link for more information.

Simply, a sign is an indication of some fact or quality; and, in everyday English, a medical sign is an "objective" indication of some medical fact or quality that is detected by a physician during a physical examination of a patient—such as elevated
..... Click the link for more information.

For other uses of "ICD", see ICD (disambiguation).

The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD
..... Click the link for more information.

List of ICD-10 codes. The version for 2007 is available online at [1]

Chapter Blocks Title
I Certain infectious and parasitic diseases
II Neoplasms
III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
..... Click the link for more information.

For other uses of "ICD", see ICD (disambiguation).

The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD
..... Click the link for more information.

The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. These codes are in the public domain.

Definition controversy

The name amyloid comes from the early mistaken identification of the substance as starch (amylum
..... Click the link for more information.

Carcinoid
Classification & external resources

Picture of a carcinoid tumour that encroaches into lumen of the small bowel (centre of image). Pathology specimen. The prominent folds are plicae circulares, a characteristic of small bowel.
ICD-10 E 34.
..... Click the link for more information.

MeSH D046789

Chondromalacia Patellae (also known as CMP, Patello-femoral Pain Syndrome, or Runner's Knee) is a degenerative condition of the cartilage surface of the back of the knee cap, or patella.
..... Click the link for more information.

MeSH D001014 An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location.
..... Click the link for more information.

Lobectomy means surgical excision of a lobe. This may refer to a lobe of the lung, a lobe of the thyroid or a lobe of the brain (as in anterior temporal lobectomy).
..... Click the link for more information.

A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. It is also sometimes called a "stricture" (as in urethral stricture).

Stenoses of the vascular type are often associated with a noise (bruit) resulting from turbulent flow over the
..... Click the link for more information.

trachea, or windpipe, is a tube that has an inner diameter of about 20-25 mm and a length of about 10-16cm. It extends from the larynx to the primary (main) bronchi in mammals, and from the pharynx to the syrinx in birds, allowing the passage of air to the lungs.
..... Click the link for more information.

In animal physiology, respiration is the transport of oxygen from the ambient air to the tissue cells and the transport of carbon dioxide in the opposite direction. This is in contrast to the biochemical definition of respiration, which refers to cellular respiration
..... Click the link for more information.

The bronchioles are the first airway branches that no longer contain cartilage. They are branches of the bronchi, and are smaller than one millimeter in diameter.

There are no glands or cartilage in any of the bronchioles, and the epithelial cells become more cuboidal in
..... Click the link for more information.

Spirometry (meaning the measuring of breath) is the most common of the Pulmonary Function Tests (PFTs), measuring lung function, specifically the measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled.
..... Click the link for more information.

For malignant tumors specifically, see .

Tumor or tumour (via Old French tumour from Latin tumor "swelling") is an abnormal growth or mass of tissue. A tumor can be either malignant or benign.
..... Click the link for more information.

Monotone refers to a sound, for example speech or music, that has a single unvaried tone.

Monotone or monotonicity may also refer to:

Monotone (software), an open source revision control system
Monotone class theorem, in measure theory

..... Click the link for more information.

This article is copied from an article on Wikipedia.org - the free encyclopedia created and edited by online user community. The text was not checked or edited by anyone on our staff. Although the vast majority of the wikipedia encyclopedia articles provide accurate and timely information please do not assume the accuracy of any particular article. This article is distributed under the terms of GNU Free Documentation License.

Herod_Archelaus

iPedia Free Information Center