By Dr Unnikrishnan
A continuous coarse whistling sound produced in the respiratory system while breathing known as wheezing is experienced by 10-15% of the population. As soon as you notice that this sound is persistent in your chest, you may have something to worry about, regarding your overall health. Wheezing may be caused due to asthma attacks or in worst cases may even be a symptom of lung cancer.
What is wheezing?
Wheezing is a high pitched whistling sound during breathing. It occurs when air moves through narrowed breathing tubes. The sound is caused by air that is forced through airways that are narrower than normal. When wheezing is accompanied by breathing difficulty, it may be a medical emergency.
Wheezing is a sign that a person may be having breathing problems. The sound of wheezing is most obvious when breathing out (exhaling), but may be heard when taking a breath (inhaling).
Wheezing most often comes from the small breathing tubes (bronchial tubes) deep in the chest, but it may be due to a blockage in larger airways or in persons with certain vocal cord problems. Narrowed airways can be due to:
l Bronchospasm: It is a condition when the muscle within the lining of the airways contracts. This has an effect of narrowing (constricting) the airways.
l Swelling of the lining of the airways.
l A lot of secretions (mucus, etc) in the airways.
l An inhaled object. For example, if you inhale a peanut (which is not uncommon in children).
l An abnormal growth in the airway, such as a tumour (cancer).
What are the causes of wheezing?
There are many possible causes. Few of the common and important causes are as mentioned below:
Asthma
It is a condition that affects the smaller airways (bronchioles).Although asthma can start at any age, commonly it starts in childhood. At least one in 10 children, and one in 20 adults, have asthma. The common symptoms are cough and wheeze. In the case of asthma, you may also become breathless, and develop a feeling of chest tightness. Symptoms can range from mild to severe between different people, and at different times in the same person.
Chronic obstructive pulmonary disease (COPD)
It is a general term which includes the conditions chronic bronchitis and emphysema. Chronic means persistent. Bronchitis is inflammation of the airways of the lungs (bronchi). Chronic bronchitis and emphysema commonly occur together. The term COPD is used to describe airflow obstruction due to chronic bronchitis, emphysema, or both. The main cause of COPD is smoking and it mainly affects the older age group.
Bronchiectasis
It is an abnormal widening of one or more airways. Extra mucus develops in the abnormal airways, which is prone to infection. The main symptom is a cough which produces a lot of sputum. You may also cough up some blood from the abnormal inflamed airway and become wheezy. There are various underlying causes of bronchiectasis. For example, a previous severe lung infection, some inherited conditions, and some other conditions that can damage part of an airway.
Bronchiolitis
It is an infection of the small airways of the lung (the bronchioles). It is a common health condition in babies. Most affected babies are not seriously ill, and make a full recovery. If it gets more serious, hospital care may be needed. It is usually caused by a virus called the respiratory syncytial virus (RSV).
Other infections
An infection anywhere in the respiratory tract may trigger wheezing. For example, infection of the bronchi is common in adults and may cause some wheezing in addition to other symptoms. A viral respiratory infection is a common cause in young children.
An inhaled object
An inhaled object such as a peanut may partially block one of the bronchi.
Less common causes
Include lung cancer, various inflammatory conditions, and various uncommon and rare lung disorders.
Seek medical advice about wheezing if:
l Wheezing is accompanied by a temperature of 38C (101F) or above. It might be a case of respiratory infection such as acute bronchitis, or pneumonia.
l Breathing is so difficult that you feel you are suffocating. This can be a sign of a severe asthma episode or an allergic reaction (anaphylaxis); call 999 to get medical help immediately.
l You wheeze frequently and cough up greenish or grey phlegm. You may have chronic bronchitis, emphysema, or COPD.
l You begin wheezing suddenly and cough up frothy pink or white phlegm. This may be a sign of heart failure.
l You cough up bloody phlegm, feel breathless or you have a sharp, localised chest pain; this could be a sign of pulmonary embolism.
How do I find out what’s causing my wheezing?
To determine the cause of your wheezing, doctor will ask questions to determine your symptoms and what leads to them. For example, if you have no history of lung disease and you always wheeze after eating a certain food or at a certain time of year, your doctor may suspect that you have a food or respiratory allergy.
With the stethoscope, your doctor can listen to your lungs and find out how much wheezing you have.
For the first time evaluation, your doctor will probably ask you to perform a breathing test (spirometry) and also carry out chest X-ray.
Other blood tests and procedures may be necessary depending on what your doctor learns from talking with you and examining you.
If it seems like you have allergies that may be related to your wheezing, there are a variety of other tests your doctor may use to verify allergies, including skin testing or blood tests (an eosinophil count or IgE levels). Tests that are commonly done include a chest and lung function tests.
What are the treatments for wheezing?
Firstly, you must seek medical advice to determine the cause of your wheezing and then receive treatment for the specific cause.
If your wheezing is caused by asthma, your doctor may recommend some or all of the following to reduce inflammation and open the airways:
A fast-acting bronchodilator inhaler (to dilate constricted airways when you have respiratory symptoms).
An inhaled corticosteroid.
A long-acting bronchodilator.
An asthma controller tablet to reduce airway inflammation.
A non-sedating antihistamine or a nasal spray if you have nasal allergies.
If you have acute bronchitis, your doctor may recommend some or all of the following:
l A fast-acting bronchodilator (such as terbutaline or salbutamol) to help ease the wheezing as the infection clears.
l An antibiotic if you have an underlying lung problem.
l Generally, any mild wheezing that accompanies acute bronchitis disappears when the infection does.
When wheezing is so severe that it is difficult or nearly impossible for you to breathe, call 999 immediately for medical help. A medical team may administer any of the following that may be needed:
l Intravenous adrenaline if the wheeze is due to a hypersensitivity (allergic) reaction.
l Oxygen.
l A corticosteroid (such as prednisolone).
l A mechanical ventilator or CPAP machine to help you breathe.
l Frequent or continuous nebuliser (breathing) treatments.
- Dr Unnikrishnan is an ENT Specialist at Aster Medical Centre in Al Khor.
BREATHING TROUBLE: In the case of asthma, you may also become breathless, and develop a feeling of chest tightness.
