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Wheezing

Wheezing is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Result of turbulent airflow:
    • High-pitched sound with dominant frequency at 400 Hz:
      • Gas flowing through constricted airways analogous to a vibrating reed
    • Resonant vibration of the bronchial walls when airflow velocity reaches critical values
  • Caused by airway narrowing between 2–5 mm:
    • Wheezing is very low pitched with airway diameters of 5 mm.
    • Airways of <2 mm are unable to transmit sound because the energy is lost as friction heat.
  • Airway narrowing is caused by a combination of ≥1 of the following:
    • Constriction (as with reactive airway disease)
    • Peribronchial interstitial edema
    • Inflammation
    • Obstruction

Etiology

  • Pulmonary (small airway):
    • Asthma
    • Acute respiratory distress syndrome
    • Anaphylaxis
    • Aspiration pneumonia:
      • Wheezing occurs early in the disease due to intense bronchospasm following the event.
    • Byssinosis:
      • Occupational lung disease of textile workers exposed to cotton dust
    • Drugs:
      • Can precipitate angioedema or allergic reaction
      • ACE inhibitors
      • β-blockers
      • Aspirin and NSAIDs
    • Forced exhalation in normal patients
    • Hyperventilation
    • Chronic obstructive pulmonary disease
    • Chronic cor pulmonale
    • Chemical pneumonitis
    • Carcinoid tumors
    • Paroxysmal nocturnal dyspnea
    • Pulmonary edema
    • Pulmonary embolism:
      • Rarely associated with wheezing
      • Focal
    • Pneumonia
    • Sleep apnea
  • Pulmonary (large airway):
    • Vocal cord dysfunction (paralysis, paradoxical movement)
    • Foreign body
    • Epiglottitis:
      • Wheezing associated with stridor in 10% of cases
    • Diphtheria
    • Smoke inhalation
    • Bronchial tumor
    • Tracheal tumor

Pediatric Considerations
  • Viral bronchiolitis in patients <3 yr of age
  • Asthma
  • Infection:
    • Croup
    • Rhinovirus
  • Foreign-body aspiration
  • Congenital abnormalities:
    • Tracheomalacia
    • Tracheal stenosis
  • Cystic fibrosis
  • CHF

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Citation

Rosen, Peter, et al., editors. "Wheezing." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307523/all/Wheezing.
Wheezing. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307523/all/Wheezing. Accessed April 25, 2019.
Wheezing. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307523/all/Wheezing
Wheezing [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307523/all/Wheezing.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Wheezing ID - 307523 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307523/all/Wheezing PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -