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 in the room and begins his exam. After asking you what might have set off your asthma, he 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 his 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. Doesn’t mean my asthma is worse or better than anyone else’s, it’s just different. I’ve said it before that asthma is not a one size it’s 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 times mimic asthma. VCD can be set off by similar asthma triggers & irritants, or having an upper respiratory tract infection. It can also be aggravated from 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.)

Sinusitis
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.

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 work up is necessary. Proper diagnostic testing such as pulmonary function testing and possibly a methacholine challenge are 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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Asthma.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (9)
  • Ritahelen
    5 months ago

    This article has made me feel so much better about all the times I have been miserable and the doctor has told me that my lungs were clear because I was not wheezing. They often comment on the tightness, but there have been times when I felt a little bit like I was being scolded and to cut it out.

  • Leon Lebowitz, RRT moderator
    5 months ago

    Hi again, Ritahelen, and glad to hear this article resonated so clearly with you. Others in our community have expressed similar sentiments about their own asthma and the absence of wheezing. I thought you might also find it helpful to look over this article which discusses asthma similarly: https://asthma.net/living/silent-asthma-what-you-need-to-know/. Wishing you well, Leon (site moderator)

  • momofcutecat
    1 year ago

    Theresa i really liked your post a lot. i totally get it as well. my family doctor has heard me wheezing a few times but not often. more often times when i am in his office for asthma or bronchitis he is like oh your in a bad flare up or your chest sounds really tight i am really worried that it might turn into pneumonia with how tight you sound. if i am not wheezing my doc will comment on how tight i sound. i do not feel tight but he can hear how tight i sound. the first time i went to him for being sick he commented how tight i sounded and was really worried for me so he said can i give you a neb treatment before you leave and i said yes. more times then not when i see my fam doc for being sick he will make sure i get a neb treatment in his office before i leave, as he is usually worried about it turning into pneumonia on me. now the ER on the other hand is a dif story. i go to the ER when my neb fails me and all and i am made to wait for hours i go back to a room they listen to me and say no wheezing you are fine and they send me home no treatment at all. half the time i go to the ER i am having pain when taking a deep breath and my neb treatments are not lasting me more then 2 hours and they still keep you waiting and still tell you that you are ok and send you home with not even a neb treatment. one time i sat in the ER for 3 hours with pain when breathing and my neb was working lasting and while waiting i was coughing so bad and was wornout from it and needed care and then i ended up not getting any. i am gonna take your advice and next time i go to the ER i am gonna ask for a respiratory therapist and see if they can help me better then the ER doc who only spends like 5 minutes or less with me. one time i was the in the ER i said i had trouble breathing and when in pain and the person i saw said nothing wrong with you and when i said my doc really wanted me to have steroids put into me via iv whatever they said no needed now, they did give me oral ones to take home but said to take only if i get worse and i am sitting there thinking hello idiot i having trouble breathing right now and you sending me home to take meds only if i get worse. my main asthma symptom is coughing, sometimes i get short of breath and have trouble taking deep breathes without being in pain, i do wheeze but very seldom, and my doc has said that i sounded tight before. i am tempted to get my asthma doc to write me a note telling ER docs that i do not typically wheeze and that just because i am not wheezing does not mean that you can send me home. i totally feel you here Theresa. do you think my idea is good to get a note saying that i do typically do not wheeze? and if being tight worse then wheezing?

  • thobie
    3 years ago

    Hie Theressa. I can totally relate to your story so I understand your frustrations.

    1. Most General Practitioners have blatantly refused to put me on the nebulizer when I am suffocating from inside because there are no medical symptoms justifying I be put on the nebulizer.

    2. A psychiatrist has attributed my shortness of breath to anxiety

    3. My asthma specialist said “that’s not asthma”.

    So I’ve done a bit of my own research and I wonder might we be suffering from pulmonary hypertension?

    I live in Zimbabwe so we don’t have pulmonary hypertension specialists so I’d be really grateful if we worked on researching that angle together.

    I generally just suffocate from within, I feel my bronchioles (constricting, and occasionally my lungs just hurt. I run out of breath even when there is plenty of air. The salbutamol inhaler helps open up my bronchioles and I actually feel them expand on taking it. But the expansion comes with pain.

    No doctor ever believes me so I’m not really sure what to say anymore. I manage my feelings better now so I avoid getting frustrated as it only makes my chest tighter.

  • thobie
    3 years ago

    Hie Theressa. I can totally relate to your story so I understand your frustrations.

    1. Most General Practitioners have blatantly refused to put me on the nubuliser when I am suffocating from inside because there are no medical symptoms justifying I be put on the nebuliser.

    2. A psychiatrist has attributed my shortness of breath to anxiety

    3. My asthma specialist said “that’s not asthma”.

    So I’ve done a bit of my own research and I wonder might we be suffering from pulmonary hypertension?

    I live in Zimbabwe so we don’t have pulmonary hypertension specialists so I’d be really grateful if we worked on researching that angle together.

    I generally just suffocate from within, I feel my bronchioles ( constricting, and occasionally my lungs just hurt. I run out of breath even when there is plenty of air. The salbutamol inhaler helps open up my bronchioles and I actually feel them expand on taking it. But the expansion comes with pain.

    No doctor ever believes so I’m not really sure wh

  • thobie
    3 years ago

    Please read the complete message above. Not sure how to delete this one, it’s incomplete and has a lot of spelling errors

  • Ozark Yankee
    3 years ago

    Nice to know someone else doesn’t wheeze. I rarely wheeze even when m y asthma is a total mess. Have never been to the ER so haven’t had to deal with that. My Doc is good with and she doesn’t question the lack of wheezing. Takes the other symptoms into account and moves ahead. Seems like ER docs, from what I hear, tend to attribute a lot to anxiety, especially if they are dealing with females. I also have coronary microvascular disease and know a lot of my fellow female suffer go to the ER and are passed off as anxiety cases. Since we know our bodies, it would behoove docs to listen a bit more closely and take us seriously.

  • Leon Lebowitz, RRT moderator
    3 years ago

    Hi Ozark Yankee and thanks so much for taking the time to share you asthma experiences with the community. It sounds like you have an excellent physician; one who listens and knows how to treat you.
    Warm regards,
    Leon (site moderator)

  • Leon Lebowitz, RRT moderator
    3 years ago

    This is an excellent article, Theresa! I’m sure you’ll appreciate that for some asthmatics, a ‘silent chest’ can be an extremely serious symptom. No wheezing, as you pointed out, can be indicative of little to no air movement. When there is no air movement, if unrecognized, the results can be disastrous. I like to think that every experienced asthmatic knows their asthma ‘best’ and should be able to guide the health care provider to the most effective treatment for themselves.
    All the best,
    Leon (site moderator)

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