Emergency Medicine/Wheezing

Wheezing is a high-pitched whistling sound produced by expiratory air flowing through narrowed breathing tubes, especially the smaller ones deep in the lung. It is a common finding in asthma and chronic obstructive pulmonary disease (COPD).

Causes

• Asthma
• Bronchiectasis
• Bronchiolitis
• Bronchitis
• Emphysema (COPD)
• Pulmonary Oedema / Heart failure (cardiac asthma)
• Allergic reaction
• Inhalation of foreign matter into the lungs (especially in children)

Conditions which may exacerbate existing underlying asthmatic tendency include

• Gastroesophageal reflux disease
• Viral infection, especially in infants younger than 2 years old
• Pneumonia
• Smoking
• Medications (many asthmatics wheeze after taking aspirin or NSAID)

Treatment

• Drugs to relieve narrowing of the airways, (beta agonist)such as albuterol, are usually given by inhalation or nebulisation. These are referred as rescue medication.
• Steroids are extremely important component in the treatment as airway inflammation has now been proved to be the major component of the disease. Steroids may be given orally during the acute phase treatment, but are usually given by inhalers in the long term treatment(so called 'preventors').
• Hospitalization may be required if the patient's breathing is particularly difficult, or if close observation by medical personnel, intravenous medications, supplemental oxygen are required. In any case, the patient needs to be closely monitored as asthma can deteriorate rapidly.

If a diagnosis is made related to wheezing such as asthma or COPD, further action to treat and manage the condition will be needed.