Wheeze
Overview
Wheezing is an unpleasant symptom that often occurs in patients with exacerbations of asthma, COPD, heart failure or allergies. Ask about possible precipitants for the patient's wheeze, and if in doubt consider rarer causes such as Churg-Strauss or carcinoid syndrome.
Aetiology
Causes of Wheeze
- Obstructive lung disease - asthma, COPD
- Left ventricular failure (pulmonary oedema)
- Allergy (angioedema)
- Aspiration
- Bronchial / tracheal obstruction - foreign body, tumour, stenosis
- Carcinoid syndrome
- Churg-Strauss syndrome
- Allergic bronchopulmonary aspergillosis (ABPA)
Asthma Triggers
- Environmental - pollen, tobacco smoke, pollutants
- Medications - beta blockers, ACE inhibitors, NSAIDs
- Exercise
- Stress
- Respiratory infections
- Gastroesophageal reflux
History of Presenting Complaint
Onset
When the wheeze started, and under what circumstances.- Onset post eatingAllergy, aspiration or reflux (asthmatics)
- Onset post new medicationPotential allergic drug reaction
Associated Symptoms
Whether the wheeze is associated with any other symptoms.- Associated with shortness of breathNonspecific symptom of cardiorespiratory disease
- Associated with paroxysmal nocturnal dyspnoeaSuggestive of heart failure
- Fevers and coryzal symptoms / cough in an asthmaticSuggestive of infective exacerbation
- Associated with haemoptysisConcerning for lung cancer
Exacerbating Factors
Whether there is anything that triggered the wheeze or makes it worse.- Worse on lying downSuggestive of heart failure or reflux (asthmatics)
- Exacerbated by environmental triggersSuggestive of asthma / allergies
Alleviating Factors
Whether there is anything that relieves the wheeze.- Relieved with bronchodilatorSuggestive of asthma / COPD
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