Wheeze

Wheeze is a typical symptom of asthma, together with cough, shortness of breath, and chest tightness.1 Wheezing has been described as a musical, high pitched, or whistling noise that is usually heard when breathing out. In severe asthma, wheezing can be heard while breathing out and in.1

Wheezing happens during exhalation because air is trying to pass rapidly through narrow airways.2 Children wheeze more than adults, in part because their airways are smaller.2

Wheezing is a symptom of many lung conditions. Not everyone who wheezes has asthma, nor does everyone with asthma wheeze. Wheezing is very common in young children, especially when they have colds.3

What other conditions can cause wheeze?

Asthma is the most common reason for wheezing in children. Allergies, colds, gastroesophageal reflux disease, and obstructive sleep apnea are other common causes of childhood wheeze.2

In adults, chronic obstructive pulmonary disease and asthma are the main causes of wheeze.4 Other causes include postnasal drip syndrome, infections, congestive heart failure, and obstruction of the windpipe and large airways due to tumors, scarring, or excessive mucus.

How common is wheeze?

More than 25% of infants have at least one wheezing episode.2 By age six, nearly 50% of children have had a wheezing episode.

Wheeze that starts in childhood and continues past age three years typically continues into adulthood.5 In fact, research has shown that wheezing that seems to start in adulthood probably has its origins in childhood.5 In one study, 94% of people who went to the emergency room for an asthma flare-up reported wheezing as one of their symptoms.6

How is wheeze evaluated?

Your medical history and physical examination help to narrow down the cause of wheeze. Your provider may ask questions such as:4

  • How frequently do you wheeze?
  • What other breathing symptoms have you noticed?
  • Are you taking medications for asthma, such as rescue inhalers or inhaled corticosteroids? Does the wheeze get better after taking them?
  • Are you a current, former, or never smoker?
  • Are you exposed to irritating chemicals at work or at home?

When evaluating a child with wheeze, your child’s provider may ask questions such as:2

  • Do any close relatives of the child have asthma or allergic diseases such as eczema, hay fever, or food allergies?
  • Has anyone in the family been sick lately?
  • How often does your child wheeze?
  • What other breathing symptoms have you noticed?

Your provider will listen to the wheeze, making note of how it sounds. Your provider will determine whether you wheeze during inhalation or exhalation. He or she will try to figure out where the wheeze starts in your airways.

When the medical history and physical exam point to asthma, your provider will probably want you to do spirometry.4 Spirometry is the most important lung function test for adults and children ages five and older. This test determines how much and how quickly you can exhale air. The test is usually done before and after taking a medication that opens the airways (“bronchodilator”). Asthma is likely if medications are able to open the airways.

If the wheeze does not seem like it is caused by asthma, a chest x-ray or CT scan may be needed to check for other causes.4

How is asthma-related wheeze treated?

If wheezing caused by intermittent asthma, your provider may prescribe a rescue inhaler for use as needed. Signs of intermittent asthma are:7

  • Symptoms occur two days per week or less.
  • Symptoms do not limit normal activity.
  • Symptoms rarely wake you up at night.

If wheezing and other symptoms occur more frequently, your provider may recommend starting treatment for asthma. Initial treatment of asthma usually involves inhaled corticosteroids.7 For very young children with suspected asthma, a two to three month trial of low-dose inhaled corticosteroids can be helpful in making the diagnosis.3 Your child’s provider will want to see if your child’s symptoms get better with medication and get worse when the medications stop.

Written by: Sarah O'Brien | Last Reviewed: May 2016.
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