|
|
| (34 intermediate revisions by 7 users not shown) |
| Line 1: |
Line 1: |
| {{Infobox_Disease | | | __NOTOC__ |
| Name = Wheeze |
| | {{Wheeze}} |
| ICD10 = {{ICD10|R|06|2|r|00}} |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| ICD9 = {{ICD9|786.07}} |
| |
| }}
| |
| {{Search infobox}}
| |
| {{CMG}}
| |
|
| |
|
| {{Editor Help}} | | {{CMG}}; {{JFS}} |
|
| |
|
| A '''wheeze''' 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]], a form of [[reactive airway disease]].
| | ==[[Wheeze overview|Overview]]== |
|
| |
|
| == Characteristics == | | ==[[Wheeze pathophysiology|Pathophysiology]]== |
|
| |
|
| Wheezes occupy different portions of the [[respiration (physiology)|respiratory]] cycle depending on the site of airway obstruction and its nature. The proportion of the respiratory cycle occupied by the wheeze roughly corresponds to the degree of airway obstruction.{{rf|1|Baughman}}<sup>,</sup>{{rf|2|Pasterkamp}} [[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.{{rf|3|Shim}} 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 monotonal, occurs throughout the inspiratory phase (ie. is "holoinspiratory"), and is heard more [[Anatomical position|distally]], in the [[Vertebrate trachea|trachea]]. Inspiratory wheezing also occurs in hypersensitivity pneumonitis.{{rf|4|Earis}} 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.
| | ==[[Wheeze causes|Causes]]== |
|
| |
|
| 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, whence 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.{{rf|5|Meslier}}
| | ==[[Wheeze differential diagnosis|Differentiating Wheeze from other Conditions]]== |
|
| |
|
| Wheezing can also occur in people who are not in shape. Wheezing is not a severe problem. The more often you run, the easier breathing gets.
| | == [[Wheeze epidemiology and demographics|Epidemiology and Demographics]] == |
|
| |
|
| A special type of wheeze is '''[[stridor]]'''. Stridor — the word is from the Latin, ''strīdor''{{rf|6|OED}} — 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)."{{rf|7|Sapira}} 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.
| | == [[Wheeze risk factors|Risk Factors]] == |
|
| |
|
| The [[differential diagnosis]] of wheezing is wide, and the cause of 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.
| | == [[Wheeze natural history|Natural History, Complications and Prognosis]] == |
|
| |
|
| ===Complete Differential Diagnosis of the Causes of Wheeze=== | | == Diagnosis == |
| (In alphabetical order)
| |
| *Abnormal arytenoid movement
| |
| *[[Allergic bronchopulmonary aspergillosis]]
| |
| *Amyloid deposition
| |
| *[[Anaphylaxis]]
| |
| *[[Angioedema]]
| |
| *[[Aspiration]](foreign particles or foods)
| |
| *[[Asthma]] including status asthmaticus
| |
| *Benign airway [[tumors]]
| |
| *Bilateral vocal cord paralysis
| |
| *[[Bronchiectasis]]
| |
| *[[Bronchiolitis]]
| |
| *[[Bronchiolitis obliterans]]
| |
| *[[Bronchitis]] (bacterial or viral)
| |
| *[[Bronchopulmonary dysplasia]]
| |
| *[[Carcinoid syndrome]]
| |
| *Cardiac asthma ( pulmonary edema)
| |
| *[[Cardiomegaly]]
| |
| *[[Chondromalacia]]
| |
| *[[Chronic obstructive pulmonary disease]]: Chronic bronchitis and Emphysema
| |
| *Cold induced [[wheezing]]
| |
| *[[Congenital abnormalities]]
| |
| *Cricoarytenoid arthritis
| |
| *[[Cystic fibrosis]]
| |
| *Descending aortic [[aneurysm]]
| |
| *Esophageal foreign body
| |
| *[[Gastroesophageal Reflux Disease]] (with aspiration)
| |
| *[[Hemorrhage]], pulmonary
| |
| *Hypertrophied [[tonsils]]
| |
| *[[Immunodeficiency]]
| |
| *[[Infection]] ( [[pneumonia]] )
| |
| *[[Interstitial lung disease]]
| |
| *Intrathoracic [[goiter]]
| |
| *[[Klebsiella]] rhinoscleroma
| |
| *[[Laryngeal edema]]
| |
| *[[Laryngocele]]
| |
| *Laryngostenosis
| |
| *[[Laryngotracheobronchitis]]
| |
| *[[Lymphadenopathy]]
| |
| *Lymphangitic carcinomatosis
| |
| *[[Malignancy]] ( bronchogenic tumors)
| |
| *Medication-induced bronchoconstriction
| |
| *[[Milk allergy]]
| |
| *Mobile supraglottic soft tissue
| |
| *[[Obesity]]
| |
| *[[Parasitic infections]]
| |
| *Paroxysmal vocal cord motion
| |
| *Postextubation [[granuloma]]
| |
| *Postlobectomy bronchial torsion
| |
| *Postnasal drip syndrome
| |
| *Postradiation [[stenosis]]
| |
| *[[Primary ciliary dyskinesia]]
| |
| *[[Pulmonary edema]]
| |
| *[[Pulmonary embolism]]
| |
| *[[Relapsing polychondritis]]
| |
| *Retained foreign body (trachea or esophagus)
| |
| *[[Retropharyngeal abscess]]
| |
| *Right sided aortic arch
| |
| *Supraglottitis
| |
| *[[Tracheal stenosis]]
| |
| *Tracheo-broncheal tumors
| |
| *[[Tracheobronchitis]]
| |
| *[[Tracheobronchomegaly]]
| |
| *[[Tracheomalacia]]
| |
| *Vascular compression/ rings
| |
| *Vocal cord dysfunction
| |
| *Vocal cord hematoma
| |
| *[[Wegener's granulomatosis]]
| |
|
| |
|
| | [[Wheeze history and symptoms|History and Symptoms]] | [[Wheeze laboratory findings|Laboratory Findings]] | [[Wheeze chest x ray|Chest X Ray]] | [[Wheeze other imaging findings|Other Imaging Findings]] | [[Wheeze other diagnostic studies|Other Diagnostic Studies]] |
|
| |
|
| | ==Treatment== |
| | [[Wheeze medical therapy|Medical Therapy]] | [[Wheeze secondary prevention|Secondary Prevention]] | [[Wheeze cost-effectiveness of therapy| Cost-Effectiveness of Therapy]] | [[Wheeze future or investigational therapies|Future or Investigational Therapies]] |
|
| |
|
| | ==Case Studies== |
| | [[Wheeze case study one|Case #1]] |
|
| |
|
| ===Complete Differential Diagnosis of the Causes of Wheeze=== | | ==Related Chapters== |
| (By organ system)
| |
| {|style="width:75%; height:100px" border="1"
| |
| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| |
| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Chemical / poisoning'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Dermatologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Drug Side Effect'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Ear Nose Throat'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Endocrine'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Environmental'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Gastroenterologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Genetic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Hematologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Iatrogenic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Infectious Disease'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Musculoskeletal / Ortho'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Neurologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Nutritional / Metabolic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Obstetric/Gynecologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Oncologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Opthalmologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Overdose / Toxicity'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Psychiatric'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Pulmonary'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Renal / Electrolyte'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Rheum / Immune / Allergy'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Sexual'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Trauma'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Urologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Miscellaneous'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |}
| |
| | |
| | |
| [[Image:Asthma before-after.png|thumb|center|350px|'''Inflamed airways and bronchoconstriction in asthma'''. Airways narrowed as a result of the inflammatory response cause wheezing.]]
| |
| | |
| | |
| <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>:
| |
| | |
| | |
| | |
| ==See also==
| |
| * [[Rales]] | | * [[Rales]] |
| * [[Rhonchi]] | | * [[Rhonchi]] |
| | | {{WH}} |
| == References ==
| | {{WS}} |
| {{Reflist}}
| |
| | |
| ==Additional Resources==
| |
| | |
| {{ent|1|Baughman}} Baughman RP, Loudon RG. Quantitation of wheezing in acute asthma. ''Chest.'' 1984;86:718–722. PMID 6488909
| |
| {{ent|2|Pasterkamp}} Pasterkamp H, Asher T, Leahy F, et al. The effect of anticholinergic treatment on postexertional wheezing in asthma studied by phonopneumography and spirometry. ''Am Rev Respir Dis.'' 1985;132:16–21. PMID 3160273
| |
| {{ent|3|Shim}} Shim CS, Williams MH. Relationship of wheezing to the severity of obstruction in asthma. ''Arch Intern Med.'' 1983;143:890–892. PMID 6679232
| |
| {{ent|4|Earis}} Earis J, Marsh K, Pearson M, et al. The inspiratory squawk in extrinsic allergic alveolitis and other pulmonary fibrosis. ''Thorax.'' 1982;37:923–926. PMID 7170682
| |
| {{ent|5|Meslier}} Meslier N, Charbonneau G, Racineux JL. Wheezes. ''Eur Respir J.'' 1995;8(11):1942-8. PMID 8620967
| |
| {{ent|6|OED}} 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.
| |
| {{ent|7|Sapira}} Orient JM. ''Sapira's Art & Science of Bedside Diagnosis'' 2nd ed. Philadelphia: Lippincott William Wilkins, 2000. ISBN 0-683-30714-2
| |
| | |
| {{Symptoms and signs}}
| |
| {{SIB}}
| |
| {{WikiDoc Help Menu}} | |
| {{WikiDoc Sources}} | |
|
| |
|
| [[Category:Medical signs]] | | [[Category:Medical signs]] |