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Wheezes are continuous, coarse, whistling sounds produced in the respiratory airways during breathing. For wheezes to occur, some part of the respiratory tree must be narrowed or obstructed, or airflow velocity within the respiratory tree must be heightened. Wheezing is commonly experienced by persons with a lung disease; the most common cause of recurrent wheezing is asthma, a form of reactive airway disease.
The differential diagnosis of wheezing is wide, and the cause of wheezing in a given patient is determined by considering the characteristics of the wheezes and the historical and clinical findings made by the examining physician.

The causes of wheezing

Common causes of wheezing are:
Less common causes of wheezing include:
  • Amyloid deposition
  • Carcinoid syndrome
  • Chondromalacia
  • Descending aortic aneurysms
  • Postlobectomy bronchial torsion
  • Postradiation stenosis
  • Tracheo-broncheal tumors
  • Tracheal stenosis
  • Tracheomalacia

Characteristics

Wheezes occupy different portions of the respiratory cycle depending on the site of airway obstruction and its nature. The proportion of the respiratory cycle occupied by the wheeze roughly corresponds to the degree of bronchial obstruction., Bronchiolar disease usually causes wheezing that occurs in the expiratory phase of respiration. The presence of expiratory phase wheezing signifies that the patient's peak expiratory flow rate is less than 50% of normal. Wheezing heard in the inspiratory phase is often a sign of a stiff stenosis, usually caused by tumors, foreign bodies or scarring. This is especially true if the wheeze is monotonal, occurs throughout the inspiratory phase (ie. is "holoinspiratory"), and is heard more distally, in the trachea. Inspiratory wheezing also occurs in hypersensitivity pneumonitis. Wheezes heard at the end of both expiratory and inspiratory phases usually signify the periodic opening of deflated alveoli.

References

Baughman RP, Loudon RG. Quantitation of wheezing in acute asthma. ''Chest.'' 1984;86:718–722. PMID 6488909 Pasterkamp H, Asher T, Leahy F, et al. The effect of anticholinergic treatment on postexertional wheezing in asthma studied by phonopneumography and spirometry. ''Am Rev Respir Dis.'' 1985;132:16–21. PMID 3160273 Shim CS, Williams MH. Relationship of wheezing to the severity of obstruction in asthma. ''Arch Intern Med.'' 1983;143:890–892. PMID 6679232 Earis J, Marsh K, Pearson M, et al. The inspiratory squawk in extrinsic allergic alveolitis and other pulmonary fibrosis. ''Thorax.'' 1982;37:923–926. PMID 7170682