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wheeze

Etiology: 1) asthma, associated with bronchospasm - persistent high-pitched wheezes of airway inflammation - allergic bronchopulmonary aspergillosis 2) bronchitis - acute bronchitis 10-20 days - mucous production - scattered low-pitch, wheeze clears with coughing 3) Churg-Strauss disease (eosinophilic granulomatosis with polyangiitis) 4) chronic eosinophilic pneumonia 5) congestive heart failure (CHF) 6) vocal cord dysfunction - both inspiratory & expiratory wheezes [3] 7) COPD [3] 8) upper airway obstruction [3] - foreign body aspiration * gastroesophageal reflux disease (GERD) not associated with wheezing [6] 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 Special laboratory: 1) adults - pulse oximetry - pulmonary function testing - not acute bronchitis (see Etiology) - methacholine challenge test if initial spirometry normal - flow volume loop may distinguish intrathoracic from extrathoracic airway obstruction 2) for infants not responding to standard asthma treatment - fiberoptic bronchoscopy, bronchoalveolar lavage, & 24-hour esophageal pH monitoring - oral/pharyngeal swallowing study & video esophagraphy [4] 3) for adult not responding to standard asthma treatment - fiberoptic bronchoscopy for unilateral wheezing Radiology: - any patient with a focal wheeze should undergo chest CT to rule out an endobronchial lesion [2] Management: - treatment for asthma, bronchitis or COPD as indicated - albuterol inhalation - for infants without eczema, no dietary changes indicated [4] - reassurance for acute bronchitis [3]

Specific

monophonic wheeze; inspiratory monophonic wheezing; monophonic inspiratory stridor

General

sign/symptom

References

  1. The Bantom Medical Dictionary, Bantom Books, New York 1981
  2. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, American College of Physicians, Philadelphia 1998, 2012 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  4. Ren CL, Esther CR, Jr., Debley JS et al Official American Thoracic Society Clinical Practice Guidelines: Diagnostic Evaluation of Infants with Recurrent or Persistent Wheezing American Journal of Respiratory and Critical Care Medicine. 93(3) Aug 1, 2016 PMID: 27479061 http://www.atsjournals.org/doi/abs/10.1164/rccm.201604-0694ST#.V6IuK46EtRm
  5. Fein A, Morante JE, Shah AM Diagnostic Errors in Patients With Pulmonary Symptoms. Medscape. June 15, 2017 http://www.medscape.com/slideshow/diagnostic-errors-pulmonary-symptoms-6008747
  6. Divakaran S, Vaidya A, Kobzik L, Dellaripa P. All That Wheezes... N Engl J Med 2017; 377:e6. July 27, 2017 PMID: 28745993 Free full text http://www.nejm.org/doi/full/10.1056/NEJMimc1613182