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What Is Wheezing? Symptoms, Diagnosis, Treatment

What Is Wheezing/Wheezing is a high-pitched whistling sound produced by the oscillation of opposing airway walls. Wheeze can appear during expiration and inspiration and is usually caused by narrowing of some part of the airway. This includes not only smaller lower airways but also larger upper airways.

Wheezes are defined as high-pitched, continuous, adventitious lung sounds. They are produced by the oscillation of opposing airway walls whose lumen is narrowed. Although asthma is the most common cause of wheezing, a wide variety of disease processes may result in wheezing due to airway obstruction. This obstruction may be caused by airway edema, smooth muscle constriction, increased secretions, vascular congestion, mass lesions, scarring, or foreign bodies. Stridor is a special kind of wheeze described as a loud musical sound of the constant pitch, which is heard in patients with tracheal or laryngeal obstruction. The full differential diagnosis of airway obstruction should be carefully considered in any patient with wheezing or stridor.

A wheeze is a high-pitched, musical, adventitious lung sound produced by airflow through an abnormally narrowed or compressed airway(s). A wheeze is synonymous with a high-pitched or sibilant rhonchus.

Types of Wheezing

Stridor

A special type of wheeze is stridor. Stridor – the word is from the Latin, strīdor^[rx] — 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).”^[rx] 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. Biphasic stridor (occurring during both the inspiratory and expiratory phases) indicates narrowing at the level of the glottis or subglottis, the point between the upper and lower airways.

Causes of Wheezing

Since any process that reduces airway caliber generates wheeze, below are some of the many of the conditions that can cause wheeze

Asthma – This condition, in which your airways narrow, swell, and make extra mucus, can make it hard to breathe.
Allergic reactions – to pollen, chemicals, pet dander, dust, foods, or insect stings
Acute or chronic bronchitis and COPD – which can produce excess mucus in the respiratory tract and cause the lungs’ passageways to become blocked
Pneumonia – An infection that inflames the air sacs in your lungs, and they fill with fluid or pus
Bronchiolitis –This lung infection that inflames the airways and causes congestion usually affects children.
Emphysema – a lung condition that causes shortness of breath
Smoking, or breathing in smoke – can make you wheeze.
Respiratory syncytial virus – This virus can lead to bronchiolitis, a lung infection that inflames the airways and causes congestion or pneumonia.
Cystic fibrosis – an inherited disease that damages your lungs and makes the mucus extra sticky and thick
Obstruction of an airway – by a foreign body that has been inhaled (such as a coin)
Panic – A panic attack can cause a person’s throat to tighten and make breathing difficult.
Bronchitis – Bronchitis is an inflammation of the bronchial tubes that are often caused by a viral or bacterial infection.
Cold and flu – Infections that cause the common cold or flu can cause inflammation and breathing problems.
Pneumonia – Pneumonia is an infection of the lungs.
Tumor in the lungs
Congestive heart failure
Respiratory infections (croup, laryngitis)
Obstructive airway diseases (asthma,
chronic obstructive pulmonary disease, anaphylaxis, bronchiolitis)
Pulmonary peribronchial edema (congestive heart failure)
Vocal cord dysfunction (paradoxical vocal fold motion, vocal cord paralysis)
Postnasal drip
Airway compression: Intrinsic or extrinsic (squamous cell carcinomas, goiter)
Hyperdynamic airway collapse (tracheobronchomalacia)
Carcinoid tumors
Foreign body inhalation
Forced exhalation by normal individuals[rx][rx][rx]
Emphysema
Gastroesophageal reflux disease (GERD)
Heart failure
Epiglottitis (swelling of the “lid” of your windpipe)
Lung cancer
Medications (particularly aspirin)
Sleep apnea, obstructive (a condition in which breathing stops and starts during sleep)
Pneumonia
Respiratory syncytial virus (RSV) — especially in young children
Respiratory tract infection (especially in children younger than 2)
Smoking
Vocal cord dysfunction (a condition that affects vocal cord movement)
Lung cancer
Sleep apnea
Vocal cord dysfunction
Bronchitis
Pneumonia
Respiratory tract infection
Reaction to smoking
Inhaling a foreign object
Anaphylaxis
Bronchiolitis, a viral respiratory infection

Symptoms of Wheezing

Shortness of breath after exertion or due to a medical condition
Feeling smothered or suffocated as a result of breathing difficulties
Labored breathing
Tightness in the chest
Rapid, shallow breathing
Heart palpitations
Coughing
Clearly audible, loud, labored breathing
An anxious, distressed facial expression
Flaring nostrils
Protrusion of the abdomen and/or chest
Gasping
Cyanosis (pale or blue face, mouth, lips, or extremities)
Anxiousness,
Bloody sputum,
Chest injury
Chest pain,
Chest tightness
Cough
Dizziness
Fainting,
Fatigue
Heart palpitations,
Labored breathing,
Neck pain,
Pain with inspiration (pleurisy)

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Diagnosis of Wheezing

Other tests you might have include

Pulse oximetry – a device is clipped to your finger or ear lobe, and a light on it measures how much oxygen is in your blood.
Blood tests, including a complete blood count (CBC) – to see if you have anemia (when your body doesn’t make enough red blood cells) or infection and other tests to check for a blood clot or fluid in your lungs.
Chest X-ray or a computerized tomography (CT) scan – to see if you have pneumonia, blood clot in your lung, or another lung disease. A CT scan puts several X-rays taken from different angles together to make a more complete picture.
Electrocardiogram (ECG) – to measure the electrical signals from your heart to see if you’re having a heart attack and find out how fast your heart is beating and if it has a healthy rhythm.
Patients should be tested for electrolyte abnormalities – endocrine disorders (specifically hyperthyroid) drug-induced causes, infections, drug or chemical withdrawal, and echocardiography to check for structural heart disease. In patients presenting with ischemic stroke and with no prior history of AF, 72-hour Holter monitoring improves the detection rate of silent paroxysmal.[rx]
Screening spirometry – Can assess how much air you can breathe
Complete pulmonary function testing – Can evaluate your breathing capabilities in more detail than screening spirometry by measuring how much air you can breathe in and out, as well as how quickly
Arterial blood gas measurement – Provides a measure of the oxygen content of your blood, which alerts your doctors if you are becoming low in oxygen
Echocardiography – May be ordered if your EKG suggests that you have heart disease
Standard exercise treadmill testing – Evaluates your breathing when you have increased oxygen demands
Complete cardiopulmonary exercise testing – Evaluates your heart and lung function in detail

Treatment of Wheezing

Initial Stage

An important step in managing shortness of wheezing the cause, such as the tumor or a blood clot/ COPD. The doctor may also recommend the following to help relieve your symptoms

Receiving extra oxygen
Sitting in front of a fan
Breathing cooler air by lowering the temperature in a room
Breathing cleaner air by opening a window, using a humidifier, or getting rid of smoke and pet dander
Getting a sense of open space by seeing a view of the outside, opening windows, or being in an empty room
Keeping your head lifted, for example, by using pillows so that you are nearly sitting
Practicing techniques that take your focus away from the problem, such as relaxation and meditation
Bronchodilator to open your airways
Clean the air – Use an air cleaner with a HEPA filter. This will help cut down on allergens that often lead to asthma attacks.
Try breathing exercises – They can help your lungs work better, which helps with asthma symptoms like wheezing. Try these:
- Pursed lip breathing – Breathe in through your nose, and breathe out twice as long, with your lips pursed.
- Belly breathing – Breath in through your nose. Pay attention to how your belly fills with air (put your hands on it). Breathe out through your mouth for at least 2 to 3 times as long as you breathed in.

Pharmacological Treatment

Taking pain medications, such as morphine, nitroglycerin, montelukast that help control the central nervous system.
Bronchodilators to open your airways
Steroids to help reduce swelling in the lungs
Antianxiety medicines to help break the cycle of panic. This cycle can lead to more breathing problems.
Pain medicines to make breathing easier

Asthma: Your doctor will likely prescribe

Bronchodilator – This medication eases inflammation and opens your airways.
Inhaled corticosteroids to ease inflammation
Leukotriene receptor antagonists that help prevent asthma and allergy symptoms

There are pharmacologic and non-pharmacologic treatments. Pharmacologic interventions can be thought of as disease-modifying when they treat the underlying disease that triggered the shortness of breath. A symptom-based approach aims to reduce awareness of the intensity and discomfort of dyspnea.[rx][rx]

Antianxiety medications – If you are experiencing anxiety with your dyspnea, depending on the cause, your healthcare provider may prescribe an anti-anxiety medication, called an anxiolytic. These medications will help you to relax. These may include lorazepam or alprazolam. It is important to take these medications only when you are feeling anxious. Do not operate heavy machinery, or drive an automobile while taking these. These medications must be used very cautiously if you have severe dyspnea. Discuss the risks and benefits of taking this medication with your doctor or healthcare provider.
Antibiotics – If your doctor or healthcare provider suspects that you have a lung infection, he or she may order antibiotic pills or intravenous (IV), depending on how severe your illness is, and your overall health status. Commonly prescribed antibiotics for bronchitis, pneumonia and respiratory (wheezing) problems include azithromycin and levofloxacin. If you are prescribed antibiotic pills, take the full prescription. Do not stop taking pills once you feel better.
Anticholinergic agents – these drugs are given to persons with chronic bronchitis, emphysema, and chronic obstructive lung disease (COLD). Anticholinergic agents work in a complex manner by relaxing the lung muscles, which will help you to breathe easier. A commonly prescribed drug is ipratropium bromide.
Bronchodilators – These drugs work by opening (or dilating) the lung passages, and offering relief of symptoms, including shortness of breath. These drugs, typically given by inhalation (aerosol), but are also available in pill form.
Beta-adrenergic receptor agonists (beta-agonists) – Beta-agonists can be considered bronchodilators, as these drugs relax airway smooth muscle, and block the release of substances that cause bronchoconstriction, or narrowing of your lungs if you are having a lung “spasm.” Drugs such as albuterol, or terbutaline, are commonly used.
Corticosteroids – Steroids work by decreasing inflammation and swelling, which may be present with certain lung disorders. People may benefit from steroids, either inhaled, by pill form, or in the vein (IV).
Beclomethasone – an inhaled steroid, is useful in the treatment of chronic asthma and bronchitis. Inhaled steroids act directly on the lung tissue, so there are fewer long-term side effects, compared with a pill or IV form. People who have an outbreak of severe shortness of breath and airway inflammation may be ordered a steroid pill, such as prednisone, for a short period of time. This is usually given with inhaled steroids. Patients with severe asthma may require IV administration of another steroid, methylprednisolone.
Cough medications/Decongestants – may help you to be more comfortable if you are coughing a lot. Guaifenesin is an active ingredient in many cough medications, may be given alone, but is often combined with other drugs, such as codeine, to help your cough. Guaifenesin may also be combined with pseudoephedrine as a decongestant, or anyone of many medications, depending on your symptoms. Another common medication you may receive is Hydrocodone Bitartrate-Homatropine Methylbromide. This is a narcotic antitussive (anti-cough medication), which will help relieve your cough.
Diuretics – may be known as “water pills” as they work to prevent or treat lung congestion by making you urinate out extra fluid. Some examples of this medication may include furosemide and Hydrochlorothiazide. You may receive this medication alone or in combination with other medications.
Oxygen therapy – If you are experiencing shortness of breath at rest, or on exertion, your healthcare provider may see if oxygen therapy is right for you. You may take oxygen when your symptoms are at their worst. For example, some people are only on oxygen at nighttime, and not during the day. Some take oxygen when they are performing activities, but not all the time.

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Steam inhalation

Inhaling warm, moisture-rich air can be very effective for clearing the sinuses and opening up the airways.

To do this, a person can use the following method:

Pour hot water into a large bowl and breathe in the steam.
Place a towel over the head to trap extra moisture.
Add a few drops of menthol or eucalyptus oil to the water to make the stream more powerful.

Peppermint essential oil may have pain-relieving and anti-inflammatory effects. Research from 2013[rx]suggests that it may relax the muscles of the respiratory system, which could help to relieve wheezing and other respiratory problems. Peppermint essential oils can be purchased from drug stores or online[rx]. If a steam bath does not appeal to you, a sauna room or hot shower can also help loosen congestion. Gently tapping on the back or chest and breathing deeply can help the steam work even better.

Hot drinks

Warm and hot drinks can help to loosen up the airways and relieve congestion. Honey is a natural anti-inflammatory and antimicrobial, so adding a teaspoon of honey to a hot drink may further improve a person’s symptoms. A 2017 study[rx] found that eating one tablespoon of honey twice a day, along with other treatments, helped to relieve throat congestion. Some people find that peppermint or other menthol teas work well. A person can try experimenting with different teas to find one that helps.

Breathing exercises

Breathing exercises may help with COPD, bronchitis, allergies, and other common causes of wheezing. A 2009 study[rx] found that certain yoga-inspired breathing techniques could help with breathing difficulties related to bronchial asthma, including wheezing. Breathing exercises often include deep, regular inhalations and exhalations. A doctor or respiratory therapist can help with deciding the most effective breathing techniques. A person may find that they have trouble breathing during a panic attack. Deep breathing exercises can also assist here. It may help to try slow breathing, focusing on breathing deeply into the stomach, and counting breathes.

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Humidifiers

A humidifier may help to reduce wheezing. During the dry winter months, wheezing often gets worse. A humidifier in the bedroom can help loosen congestion and reduce the severity of wheezing. A person can add peppermint or other oils to the water in the humidifier, though they should check the humidifier’s instructions before adding anything other than water. Air humidifiers can be found at some supermarkets or online stores.

Air filters

Many conditions that cause wheezing can get worse when the air is polluted or in response to allergens. A home air filter can reduce the presence of irritants that may trigger wheezing and breathing trouble.

Identifying and removing triggers

Chronic illnesses such as asthma and allergies may get worse in response to certain triggers, such as stress or allergens. Controlling these triggers, as much as possible, can help. For instance, a person with a chronic respiratory condition who also has allergies might take allergy medication and avoid allergy triggers.

Allergy medications

People with allergies can benefit from a wide variety of allergy medications, including decongestants, corticosteroid tablets, and antihistamines. Nasal sprays may be especially helpful to relieve a tight chest, congestion, and inflammation that can cause wheezing. More severe allergies may require prescription allergy medication.

Allergy immunotherapy

Immunotherapy is a process of retraining the immune system not to react to allergens. The most common form of immunotherapy is allergy shots. A person may need several treatments, but over time, immunotherapy can reduce the frequency of wheezing. Immunotherapy may also be helpful for people with other chronic conditions, such as COPD, who also have allergies. Breathing exercises for people with COPD. There are several breathing exercises that can help people with COPD relieve respiratory symptoms. Learn about them here.

Bronchodilators

Bronchodilators are medications that help relax the lungs and prevent the airways from narrowing. They can help with wheezing caused by COPD and asthma.

Bronchodilators come in two forms:

Short-acting bronchodilators – Sometimes known as rescue inhalers, these can stop asthma or COPD attack.
Long-acting bronchodilators – This variety helps relax the airways over the long-term, reducing the frequency and severity of wheezing episodes.

Bronchodilators should be obtained from a doctor and can then be used at home, as needed.

Other medications

A wide variety of medications can treat wheezing that is due to an underlying illness. A person who experiences wheezing due to a severe allergic reaction, for instance, may require epinephrine or corticosteroids. People with heart health issues may take blood pressure medication or blood thinners to prevent further damage to the heart. It is vital to discuss with a doctor whether medication might help, and how various medications may interact with one another.