Thursday, September 16, 2010

Seriously, that wheeze is not Asthma!!!

As any good RT knows, not all wheezing is associated with asthma but this knowlege that we have about wheezing has not been disseminated to all the masses that walk the halls of a hospital. I know for myself that I do attempt to educatate nurses about the different types of things that can cause wheezing, for example congestive heart failure wheezes versus asthma. CHF wheezes are more wet sounding and normally are in the upper airway, just have them put their stephescope on the patients larynx and listen, then the sound "echo's" down into the lower airways. In the classic asthma wheezing it's a more cleaner wheeze and it is usually without the coarseness of the fluid buildup of the CHF wheeze, plus it tends to start in the lower airways instead of the upper, CHF of course you can hear some nice crackles also.

Here are some common reasons for that sound we call wheezing:

By Age:

Infants and Children

  • Congenital anomalies
    Bronchopulmonary dysplasia
    Vascular rings
    Cystic fibrosis
    Foreign body aspiration


  • Asthma
    Chronic obstructive pulmonary disease (COPD)
    Congestive heart failure (CHF)
    Primary endobronchial tumors
    Endobronchial metastasis (from colon, breast, melanoma, kidney, pancreas)

By Onset


  • Asthma
    Pulmonary embolism
    Aspiration syndromes
    Foreign body aspiration


  • Bronchogenic carcinoma
    Tracheal tumor
    Endobronchial metastasis



  • Aspiration syndromes
    Carcinoid syndrome
    Vocal cord dysfunction


  • Endobronchial tumor
    Tracheal stenosis
    Bilateral vocal cord paralysis
    Churg-Strauss syndrome


  • COPD
    Pulmonary infiltrates/eosinophilia syndromes

Well there you have it, i'm just throwing out things I found which might cause some wheezing in our patients and with what you can see, not everything is from Asthma or COPD there are other things which can cause this lung sound. There are different ways things can wheeze, it can be expiratory, inspiratory, both, or even considered musical but not all of those are asthma related. In reality there can even be asthma issues without even having a audible wheeze associated with it which is something that occurs quite a bit in kids. There are many people in the medical profession who hear wheezing and think, ohhh they need albuterol to stop the all and powerfull wheeze because it MUST BE ASTHMA!!!

Ok well if you would like some really good information on asthma look over at

The Respiratory Cave, Rick is well informed and educated in many things related to asthma.

Thanks for reading,

Drive on RT's

No comments: