Not All Asthmatics Wheeze and Not All Wheezing is Asthma
There are so many of us asthmatics that can relate to this scenario: You go to the doctor's office because your asthma is acting up. You are short of breath and your chest feels tight. The doctor comes into the room and begins their exam. After asking you what might have set off your asthma, they will listen to your lungs. Then you hear the words that absolutely make you cringe, "Well, you aren't wheezing...."
What is wheezing?
As a severe asthmatic myself, nothing makes me more furious than being told you are fine because you aren't wheezing by a doctor whether it is in their office or a doctor in the emergency room. You feel dismissed like they don't take you seriously or tell you you're just anxious. It's incredibly frustrating.
It's no secret that overall that cough and wheezing are the most common asthma symptoms along with shortness of breath. But it is also important to understand that not all asthmatics wheeze.
Not all asthma causes wheezing
I am one of these "silent types." When my asthma is acting up, I get short of breath and my chest feels tight. My airways close up pretty fast and never have the typical wheeze. My doctors tell me my chest sounds silent with not a lot of air movement. It's just the way my asthma is. It doesn't mean my asthma is worse or better than anyone else's--it's just different. Asthma is not a one-size-fits-all disease.
Other causes of wheezing
There are many other things that can cause a person to wheeze. They include:
Vocal cord dysfunction
Also known as VCD, this is a condition that affects vocal cord movement and can often time mimic asthma. VCD can be set off by similar asthma triggers, irritants, or having an upper respiratory tract infection. It can also be aggravated by exercise.
Congestive heart failure
Also known as CHF, this is a condition where the heart does not pump properly. It can cause a back up of fluid in the lungs which can lead to wheezing.
Upper airway obstruction
This occurs when something is actually physically blocking the upper airway, thus causing a wheeze. Examples of this would include a tumor, enlarged thyroid gland or accidentally inhaling an object which has gotten lodged in the upper airway (usually seen more in children than adults.)
Also known as a sinus infection, sinusitis is a condition where the tissue lining in the sinuses becomes inflamed. Often times this accompanies a common cold. Many times, this inflammation can cause wheezing.
Proper testing can help
These are just a few of the conditions that can cause wheezing that are not asthma. In order to rule out any other conditions, a proper asthma diagnostic workup is necessary. Proper diagnostic testing such as pulmonary function testing and possibly a methacholine challenge is essential in officially diagnosing a suspected asthmatic, particularly one who does not wheeze.
For years, my doctors suspected I had asthma but weren't completely sure because I never wheezed. They thought I might have a different lung condition. It wasn't until I had a methacholine challenge done that completely confirmed my asthma diagnosis.
If you find yourself in the midst of a doctor who is not taking your asthma seriously, I would definitely recommend getting a second or third opinion. Not all doctors have the same understanding of asthma and wheezing. It is also okay to be upfront with your doctor and tell him or her that you don't wheeze (if you are the silent type like myself). Don't be afraid to be your own advocate.
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