Introduction:
Wheezing is a high-pitched whistling sound produced while exhaling when the airway is partially blocked. Wheezes can often be heard with the help of a stethoscope, whereas some wheezes can also be heard by ear without using a stethoscope. According to Bernoulli's principle, the air is forced to pass through a narrowed airway, producing a prominent high-pitched sound known as wheezing.
Various reasons may cause narrowed airways, such as:
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Bronchospasms or constriction of the muscles of the airways.
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Mucus secretions in the airways.
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Swelling of the lining epithelium of the airways.
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Inhalation of foreign bodies.
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Abnormal proliferation of cells in the airways.
What Can Cause Wheezing?
Conditions that can cause wheezing are:
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Asthma: Bronchial asthma is a chronic inflammatory disease characterized by hyperresponsiveness of the tracheobronchial smooth muscle to a variety of stimuli, resulting in the narrowing of the airways along with increased secretion, mucosal edema, and mucus plugging. This makes it difficult for the air to flow easily through the airways, and it becomes difficult to breathe. Asthma can present as
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Cough, which typically occurs at night or early morning.
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Difficulty in breathing.
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Chest tightness.
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Wheezing.
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Allergic Reactions: Exposure to allergens such as pollen grains, dust, food, and pet dander, often cause constriction of the airways.
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Cystic Fibrosis: It is an autosomal recessive disorder that causes sticky, thick, hyper-viscous mucus to build up in the lungs. This mucus secretion is not removed; the secretions plug up ducts and the airways, leading to difficulty breathing and increasing the risk of infections. It is due to a defective gene, the cystic fibrosis transmembrane regulator (CFTR) gene. The CFTR is an epithelial anion channel in the alveolar ducts that facilitates the transfer of chloride and bicarbonate ions along with water to pass through it.
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Bronchiolitis is the inflammation of the bronchioles, often causing congestion, particularly in children.
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Chronic Obstructive Pulmonary Disease(COPD) is defined as a chronic inflammatory lung disease that results in irreversible airflow obstruction from the lungs. The leading cause of COPD is prolonged cigarette smoking. Other factors that may cause COPD are genetic disorders such as alpha one antitrypsin deficiency and occupational hazards due to long-term exposure to obnoxious chemical fumes, vapors, and dust particles, which can inflame the lung parenchyma. The liver produces the enzyme alpha one antitrypsin and then passes into the bloodstream to protect the lungs. The enzyme helps inhibit the elastase enzyme; therefore, all the elastin is broken down. COPD mainly consists of two disorders: chronic bronchitis and emphysema. These two conditions can co-occur and can vary in severity.
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Chronic Bronchitis: It is characterized by the inflammation of the lining epithelium of the bronchi. It is a condition in which sputum production for more than three months per year for more than two consecutive years due to hyperplasia of the mucous gland located in the submucosal layer of the bronchial tubules.
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Emphysema is a condition in which there is simultaneous destruction of the alveolar sac and enlargement of the lung parenchyma distal is destroyed and enlarged to the terminal bronchiole. The most significant risk factor for emphysema is cigarette smoking. Smoking stimulates inflammatory cells, such as macrophages and polymorphonuclear cells, which release elastase and cause elastolysis and emphysema. A characteristic feature of emphysema is the barrel chest which is a rounded and enlarged chest appearance due to hyperinflation. Typically, the anteroposterior to transverse ratio is 5:7 or 1:2, but in the case of emphysema, it becomes 1:1 due to hyperinflation.
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Inhalation of the Foreign Body: It can also obstruct the airways by partially blocking the respiratory tract.
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Smoking: Inhalation of the chemicals from the smoke can often cause activation of the inflammatory mediators, leading to the narrowing of the airways.
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Respiratory Syncytial Virus(RSV): It is the most common type of viral infection affecting the lungs and the respiratory tract in small children below the age of two years. It often leads to bronchiolitis. The disease is self-limiting, and the symptoms subside within one to two weeks.
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Obstructive Sleep Apnea is the most prevalent type of sleep associated with breathing disorders. The condition occurs as the throat muscles relax, blocking the airways during sleep. A typical sign of obstructive sleep apnea is snoring loudly, especially if snoring is interrupted by periods of silence. Other signs of obstructive sleep apnea include awakening with dry mouth, abrupt awakening, gasping or choking, morning headache, and excessive daytime sleep.
What Other Tests Are to Be Done Apart From Wheezing?
Tests that can be done are
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Chest Radiograph: It can easily identify any peculiarity of the lungs, whether a mass is present or an accumulation of fluid or air, or if any kind of congestion is present in the lungs.
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Spirometry is a simple, non-invasive, and painless test used to measure lung volume and capacities. It is one of the most common pulmonary function tests. It helps to diagnose and monitor lung conditions by measuring the amount of air a person can breathe in one forced breath.
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Pulse Oximetry: It is a probe that checks the oxygen saturation level of the blood.
How Is Wheezing Treated?
Management of wheezing can depend upon the management of the underlying cause. For example, in the case of :
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Asthma: Bronchodilators such as short and long-acting beta-agonists, anticholinergics such as Ipratropium bromide or Tiotropium, and oral corticosteroids, a potent anti-inflammatory agent such as Prednisone in high doses may be used in a severe asthma attack.
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Bronchitis: Bronchodilators, along with antibiotics, may dilate the airways and fight the bacterial infection simultaneously.
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COPD is a chronic progressive disease, and there is no cure for it. Only symptomatic relief can be provided with bronchodilators, corticosteroids, combined inhalers, antibiotics, and mucolytics.
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Cystic Fibrosis: Pseudomonas aeruginosa remains the most common pathogen in adults, whereas Staphylococcal aureus is the most common pathogen in children, and treating the pathogens with antibiotics is necessary to control the symptoms.
What Are the Remedies to Lessen Wheezing?
The following methods can reduce wheezing:
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Steam inhalation.
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Breathing exercises like pursed lip breathing and belly breathing exercises.
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Usage of HEPA (high-efficiency particulate absorbing) filters.
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Avoid smoking.
Conclusion:
Wheezing is the most significant symptom of serious health conditions, including asthma, COPD, cystic fibrosis, and congestive cardiac failure. A well-detailed history, physical examination, and lab investigations are necessary to diagnose the condition. Wheezing is usually managed by treating the underlying cause.
