Wheeze

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Definition

-  Spasmodic contraction of bronchial smooth m producing a continuous, coarse, whistling sound on respiration

 

Features

-  Noise caused by increased air velocity

-  Smaller airways = higher pitch

-  May be expiratory, inspiratory or both

-  Expiratory usually bronchiolar disease: asthma, COPD, bronchiolitis..

-  Inspiratory usually stenosis: foreign body, Ca..

-  Proprtion of respiration effected correlates to degree of obstruction

-  Localised wheeze indicates local disease: Ca, foreign body..

-  Diffuse wheeze: asthma, COPD, bronchiolitis..

 

Causes

-  COPD

-  Asthma: most common cause

-  Airway obstruction: foreign body..

-  Bronchiolitis

-  Bronchiectasis

-  Pulmonary fibrosis

-  Bronchitis

-  Alveolitis

-  Allergic rhinitis

-  URTI

-  Pneumonia

-  Recurrent PE

-  APO

-  GORD

-  Lung Ca

-  Carcinoid syndrome

 

DDx Stridor

 

Associated S/S

-  Seasonality: asthma, allergic rhinitis, bronchiolitis

-  Persistant/recurrent resp illness: CF, laryngomalacia, bronchopulmonary dysplasia

-  Smoking: COPD

-  Dyspnoea, cough + wheeze: asthma

-  <1yrs old: bronchiolitis

-  Cough

-  Post feed: GORD

-  Nocturnal: OSA, asthma, allergic rhinitis

 

Ix

-  O2 sats

-  Spirometry

-  Reversibility: asthma

-  +/- COPD

-  +/- bronchiolitis

-  Peak flow

-  +/- CXR

 

Mx

-  O2

-  +/- bronchodilator

-  As per cause