wheeze

Etiology

• asthma, associated with bronchospasm
  • allergic bronchopulmonary aspergillosis
• bronchitis
• Churg-Strauss disease (eosinophilic granulomatosis with polyangiitis)
• chronic eosinophilic pneumonia
• congestive heart failure (CHF)
• vocal cord dysfunction
  • both inspiratory & expiratory wheezes
• COPD
• upper airway obstruction
  • foreign body aspiration

* gastroesophageal reflux disease (GERD) not associated with wheezing

Clinical manifestations

• whistling or high-pitched sounds more often expiratory than inspiratory, but may be both
• prolonged expiratory phase
• may be associated cough
• dyspnea on exertion
• symptoms of allergic rhinitis may be noted
• unilateral wheezing suggests endobronchial obstruction

Diagnostic procedures

• adults
  • pulse oximetry
  • pulmonary function testing
    • methacholine challenge test
    • flow volume loop may distinguish intrathoracic from extrathoracic airway obstruction
• for infants not responding to standard asthma treatment
  • fiberoptic bronchoscopy, bronchoalveolar lavage, & 24-hour esophageal pH monitoring
  • oral/pharyngeal swallowing study & video esophagraphy
• for adult not responding to standard asthma treatment
  • fiberoptic bronchoscopy for unilateral wheezing

Management

• treatment for asthma, bronchitis or COPD as indicated
  • albuterol inhalation
• for infants without eczema, no dietary changes indicated

More general terms

• sign/symptom

More specific terms

• monophonic wheeze; inspiratory monophonic wheezing; monophonic inspiratory stridor