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wheeze

Etiology: 1) asthma, associated with bronchospasm - allergic bronchopulmonary aspergillosis 2) bronchitis 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 - methacholine challenge test - 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 Management: - treatment for asthma, bronchitis or COPD as indicated - albuterol inhalation - for infants without eczema, no dietary changes indicated [4]

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
  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