5-Minute Emergency Consult
Wheezing
Wheezing is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
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
- High-pitched sound with dominant frequency at 400 Hz:
- 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
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
- Epiglottitis
- Gastroesophageal reflux
- Foreign-body aspiration
- Congenital abnormalities:
- Tracheomalacia
- Tracheal stenosis
- Vascular ring
- Cystic fibrosis
- Cardiac disease
- Psychogenic respiratory distress
- Paradoxical vocal cord dysfunction characterized by abnormal vocal cord adduction during inspiration
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
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
- High-pitched sound with dominant frequency at 400 Hz:
- 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
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
- Epiglottitis
- Gastroesophageal reflux
- Foreign-body aspiration
- Congenital abnormalities:
- Tracheomalacia
- Tracheal stenosis
- Vascular ring
- Cystic fibrosis
- Cardiac disease
- Psychogenic respiratory distress
- Paradoxical vocal cord dysfunction characterized by abnormal vocal cord adduction during inspiration
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Citation
Schaider, Jeffrey J., 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: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307523/all/Wheezing. Accessed March 26, 2023.
Wheezing. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307523/all/Wheezing
Wheezing [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 March 26]. 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
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ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
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PB - Lippincott Williams & Wilkins
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DB - Emergency Central
DP - Unbound Medicine
ER -
