Wheeze: Difference between revisions
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== Characteristics == |
== Characteristics == |
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Wheezes occupy different portions of the [[respiration (physiology)|respiratory]] cycle depending on the site of airway obstruction and its nature. The fraction of the respiratory cycle during which a wheeze is produced roughly corresponds to the degree of airway obstruction.<ref>{{cite journal |
Wheezes occupy different portions of the [[respiration (physiology)|respiratory]] cycle depending on the site of airway obstruction and its nature. The fraction of the respiratory cycle during which a wheeze is produced roughly corresponds to the degree of airway obstruction.<ref>{{cite journal|author=Baughman RP, Loudon RG |title=Quantitation of wheezing in acute asthma |journal=Chest |volume=86 |issue=5 |pages=718–22 |date=Nov 1984 |pmid=6488909 |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=6488909 |doi=10.1378/chest.86.5.718 |format=– <sup>[http://scholar.google.co.uk/scholar?hl=en&lr=&q=intitle%3AQuantitation+of+wheezing+in+acute+asthma&as_publication=Chest&as_ylo=1984&as_yhi=1984&btnG=Search Scholar search]</sup> |deadurl=yes |archiveurl=http://web.archive.org/web/20120214031605/http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=6488909 |archivedate=February 14, 2012 }}</ref><ref>{{cite journal |author=Pasterkamp H, Tal A, Leahy F, Fenton R, Chernick V |title=The effect of anticholinergic treatment on postexertional wheezing in asthma studied by phonopneumography and spirometry |journal=Am Rev Respir Dis |volume=132 |issue=1 |pages=16–21 |date=Jul 1985 |pmid=3160273 }}</ref> [[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.<ref>{{cite journal |author=Shim CS, Williams MH |title=Relationship of wheezing to the severity of obstruction in asthma |journal=Arch Intern Med |volume=143 |issue=5 |pages=890–2 |date=May 1983 |pmid=6679232 |doi=10.1001/archinte.143.5.890 }}</ref> 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 [[monophony|monotonal]], occurs throughout the inspiratory phase (i.e. is "holoinspiratory"), and is heard more proximally, in the [[Vertebrate trachea|trachea]]. Inspiratory wheezing also occurs in hypersensitivity pneumonitis.<ref>{{cite journal |author=Earis JE, Marsh K, Pearson MG, Ogilvie CM |title=The inspiratory "squawk" in extrinsic allergic alveolitis and other pulmonary fibroses |journal=Thorax |volume=37 |issue=12 |pages=923–6 |date=Dec 1982 |pmid=7170682 |pmc=459459 |doi=10.1136/thx.37.12.923 }}</ref> 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. |
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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, hence 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.<ref>{{cite journal |author=Meslier N, Charbonneau G, Racineux JL |title=Wheezes |journal=Eur Respir J. |volume=8 |issue=11 |pages=1942–8 |date=Nov 1995 |pmid=8620967 |url=http://erj.ersjournals.com/cgi/pmidlookup?view=long&pmid=8620967 |doi=10.1183/09031936.95.08111942}}</ref> |
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, hence 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.<ref>{{cite journal |author=Meslier N, Charbonneau G, Racineux JL |title=Wheezes |journal=Eur Respir J. |volume=8 |issue=11 |pages=1942–8 |date=Nov 1995 |pmid=8620967 |url=http://erj.ersjournals.com/cgi/pmidlookup?view=long&pmid=8620967 |doi=10.1183/09031936.95.08111942}}</ref> |
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Revision as of 12:02, 29 February 2016
| Wheeze |
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A wheeze (formally called "sibilant rhonchi" in medical terminology) 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 attacks, though it can also be a symptom of lung cancer.
The differential diagnosis of wheezing is wide, and the reason for 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.
Characteristics
Wheezes occupy different portions of the respiratory cycle depending on the site of airway obstruction and its nature. The fraction of the respiratory cycle during which a wheeze is produced 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 (i.e. is "holoinspiratory"), and is heard more proximally, 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, hence 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, strīdor[6] — 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 an upper 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. 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.
Diagnosis
 | The examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject. (December 2012) |
One out of 3 preschool children and 2 out of 3 school children with recurrent wheezing/coughing are allergic.[citation needed] The reaction creates an inflammation that, in turn, can lead to a variety of symptoms such as wheezing.
Over the last decade allergy has increased by 18% in the United States.[8] Today one child in four is allergic.[citation needed] Early diagnosis of allergy is important for the development of the child later in life.[citation needed] There are many patients with symptoms suggesting eczema, rhinitis, hay fever, asthma or wheezing.
See also
- Crackles (also called "crepitations" or "rales")
- Rhonchi
- Squawk (sound)
References
- ^ Baughman RP, Loudon RG (Nov 1984). "Quantitation of wheezing in acute asthma". Chest. 86 (5): 718–22. doi:10.1378/chest.86.5.718. PMID 6488909. Archived from the original (– Scholar search) on February 14, 2012.
{{cite journal}}: External link in|format=|deadurl=ignored (|url-status=suggested) (help) - ^ Pasterkamp H, Tal A, Leahy F, Fenton R, Chernick V (Jul 1985). "The effect of anticholinergic treatment on postexertional wheezing in asthma studied by phonopneumography and spirometry". Am Rev Respir Dis. 132 (1): 16–21. PMID 3160273.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Shim CS, Williams MH (May 1983). "Relationship of wheezing to the severity of obstruction in asthma". Arch Intern Med. 143 (5): 890–2. doi:10.1001/archinte.143.5.890. PMID 6679232.
- ^ Earis JE, Marsh K, Pearson MG, Ogilvie CM (Dec 1982). "The inspiratory "squawk" in extrinsic allergic alveolitis and other pulmonary fibroses". Thorax. 37 (12): 923–6. doi:10.1136/thx.37.12.923. PMC 459459. PMID 7170682.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Meslier N, Charbonneau G, Racineux JL (Nov 1995). "Wheezes". Eur Respir J. 8 (11): 1942–8. doi:10.1183/09031936.95.08111942. PMID 8620967.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ 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.
- ^ Sapira JD, Orient JM (2000). Sapira's art & science of bedside diagnosis (2nd ed.). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-683-30714-2.
- ^ Park, Alice (2009-02-26). "Why We're Going Nuts Over Nut Allergies - TIME". Time. Retrieved 2 March 2009.
Further reading
- Godfrey S, Uwyyed K, Springer C, Avital A (Mar 2004). "Is clinical wheezing reliable as the endpoint for bronchial challenges in preschool children?". Pediatr Pulmonol. 37 (3): 193–200. doi:10.1002/ppul.10434. PMID 14966812.
{{cite journal}}: CS1 maint: multiple names: authors list (link)
External links
- Audio Breath Sounds - Multiple case studies with audio files of lung sounds.
- R.A.L.E. Repository - sound files of breath sounds