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| == [[Wheeze pathophysiology|Pathophysiology]]== | | == [[Wheeze pathophysiology|Pathophysiology]]== |
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| ==Differentiating wheezing from the more serious condition of stridor==
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| A special type of wheeze is '''[[stridor]]'''. Stridor — the word is from the Latin, ''strīdor''{{rf|6|OED}} — is a harsh, high-pitched, vibrating sound that is heard in respiratory tract obstruction. Stridor heard solely in the expiratory phase of respiration usually indicates a lower respiratory tract obstruction, "as with aspiration of a foreign body (such as the fabled pediatric peanut)."{{rf|7|Sapira}} Stridor in the inspiratory phase is usually heard with obstruction in the upper airways, such as the trachea, epiglottis, or larynx; because a block here means that no air may reach either lung, this condition is a medical emergency.
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| ==Differential diagnosis of wheezing: Common causes==
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| 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 most common cases in clinical practice are:
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| *[[Asthma]]
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| *[[Bronchitis]]
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| *[[Cardiac asthma]] or [[Congestive heart failure]]
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| *[[Chronic obstructive pulmonary disease]]: Chronic [[bronchitis]] and [[emphysema]]
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| *[[Gastroesophageal Reflux Disease]]
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| *Chronic [[sinusitis]]
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| *[[Infection]] ([[pneumonia]])
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| Medication-induced [[bronchoconstriction]]
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| ==Complete Differential Diagnosis of the Causes of Wheeze==
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| (In alphabetical order)
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| *Abnormal arytenoid movement
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| *[[Allergic bronchopulmonary aspergillosis]] ABPA
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| *[[Alpha 1-Antitrypsin Deficiency]]
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| *Amyloid deposition
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| *[[Anaphylaxis]]
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| *[[Angioedema]]
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| *[[Aspergillosis]] including [[aspergilloma]] and ABPA
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| *[[Aspiration]](foreign particles or foods)
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| *[[Asthma]] including status asthmaticus
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| *Benign airway [[tumors]] including:
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| **Bronchial adenomata syndrome
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| **Unknown ([[hamartoma]], [[clear cell]], [[teratoma]])
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| **Epithelial ([[papilloma]], [[polyps]])
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| **Mesodermal ([[fibroma]], [[lipoma]], [[leiomyoma]], [[chondroma]], granular cell tumor, sclerosing [[hemangioma]])
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| **Other (myofibroblastic tumor, xanthoma, [[amyloid]], mucosa-associated lymphoid tumor)
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| *[[Bronchiectasis]]
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| *[[Bronchiolitis]] (a common childhood disease)
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| *[[Bronchiolitis obliterans]]
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| *[[Bronchitis]] (usually viral, bacterial only in patients with tracheostomy or endotracheal intubation)
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| **[[influenza]] A and B
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| **[[parainfluenza]]
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| **[[coronavirus]] (types 1-3)
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| **[[rhinovirus]]
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| **[[respiratory syncytial virus]]
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| **human metapneumovirus
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| **Other:
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| ***[[Mycoplasma pneumoniae]]
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| ***[[Chlamydophila pneumoniae]]
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| ***[[Pertussis]]
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| *[[Bronchopulmonary dysplasia]]
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| *[[Byssinosis]] - cotton duct
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| *[[Carcinoid syndrome]]
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| *Cardiac asthma (including cardiogenic pulmonary edema)
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| *[[Cardiomegaly]] (severe cardiomegaly)
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| *Chemical poisoning (more than 50 substances have been linked to wheezing)
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| *[[Chondromalacia]]
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| *[[Chronic obstructive pulmonary disease]]: Chronic bronchitis and Emphysema
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| *Cold induced [[wheezing]] (Paediatrics)
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| *[[Ciliary dyskinesia]]-bronchiectasis
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| *[[Congenital abnormalities]] affecting the bronchial tree
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| *Cricoarytenoid arthritis
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| *[[Cystic fibrosis]]
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| *Descending aortic [[aneurysm]]
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| *Dialyzer hypersensitivity syndrome
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| *Esophageal foreign body
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| *Exercise-induced [[asthma]]
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| *Extrinsic allergic [[alveolitis]]
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| *Food allergies: numerous including:
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| **[[Peanut]] Allergy
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| *[[Gastroesophageal Reflux Disease]] (with aspiration)
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| *[[Graft-versus-host disease]]
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| *[[Hay fever]]
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| *[[Heart failure]] (see cardiogenic pulmonary edema and cardiac asthma)
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| *[[Hemorrhage]], pulmonary
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| *Hypertrophied [[tonsils]]
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| *[[Immunodeficiency]]
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| *[[Infection]] ([[pneumonia]])
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| *[[Interstitial lung disease]]
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| *Intrathoracic [[goiter]]
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| *[[Klebsiella]] rhinoscleroma
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| *[[Laryngeal edema]]
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| *[[Laryngocele]]
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| *Laryngostenosis
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| *[[Laryngotracheobronchitis]]
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| *[[Lymphadenopathy]] with large lymphnodes compressing the tracheal tree.
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| *Lymphangitic carcinomatosis
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| *[[Malignancy]] (bronchogenic)
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| **[[Squamous cell carcinoma]] with variants: papillary, clear cell, small cell, basaloid
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| **[[Small cell carcinoma]]
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| **[[Adenocarcinoma]]
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| ***Acinar
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| ***Papillary
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| ***Bronchioloalveolar carcinoma
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| ****Non-mucinous (Clara cell/type II pneumocyte type)
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| ****Mucinous (Goblet cell type)
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| ****Mixed mucinous and non-mucinous (Clara cell/type II pneumocyte/goblet cell type) or indeterminate
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| ***Solid adenocarcinoma with mucin formation
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| ***Mixed
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| ***Variants: well-differentiated fetal adenocarcinoma, mucinous ("colloid"), mucinous cystadenocarcinoma, signet ring, clear cell
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| **Large cell carcinoma with variants: large cell neuroendocrine carcinoma, combined large cell neuroendocrine carcinoma, basaloid carcinoma, lymphoepithelioma-like carcinoma, clear cell carcinoma, large cell carcinoma with rhaboid phenotype
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| **Adenosquamous carcinoma
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| **Carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements
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| ***Carcinomas with spindle and/or giant cells
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| ***Pleomorphic carcinoma
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| ***Spindle cell carcinoma
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| ***Giant cell carcinoma
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| ***Carcinosarcoma
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| ***Blastoma (Pulmonary blastoma)
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| **Carcinoid tumor
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| ***Typical carcinoid
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| ***Atypical carcinoid
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| **Carcinomas of salivary gland type
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| ***Mucoepidermoid carcinoma
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| ***Adenoid cystic carcinoma
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| **Unclassified carcinoma
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| **[[Mastocytosis]]
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| **[[Mendelson's syndrome]] (aspiration pneumonitis)
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| *Medication-induced bronchoconstriction
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| **[[ACE inhibitors]] ( cough or rarely Angioneurotic edema and wheeze)
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| **[[Sotalol]]
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| **[[Adenosine]]
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| **[[Beta blockers]]: Common; usually occurs in patients with asthma or COPD; 1-selective agents, [[labetalol]], [[esmolol]], and [[pindolol]] are better tolerated than nonselective agents.
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| **[[Dipyridamole]] (IV form only)
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| **[[Protamine]]
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| **[[NSAIDs]] includign aspirin
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| **[[Marijuana]] (chronic use)
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| *[[Milk allergy]]
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| *Mobile supraglottic soft tissue
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| *[[Obesity]]
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| *[[Parasitic infections]]
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| **[[Ascariasis]]
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| **[[Hookworm]]
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| **Paragonimiases - lung infection
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| **[[Strongyloidiasis]]
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| **[[Toxocariasis]]
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| *Paroxysmal vocal cord motion
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| *Postextubation [[granuloma]]
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| *Postlobectomy bronchial torsion
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| *Postnasal drip syndrome
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| *Postradiation [[stenosis]]
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| *[[Primary ciliary dyskinesia]]
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| *[[Psychogenic]] wheezing
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| *[[Pulmonary edema]] (cardiogenic or non-cardiogenic)
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| *[[Pulmonary embolism]]
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| *[[Pulmonary eosinophilia]]
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| *[[Relapsing polychondritis]]
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| *Retained [[foreign body]] (trachea or esophagus)
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| *[[Retropharyngeal abscess]]
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| *Right sided [[aortic arch]]
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| *[[Sinusitis]] ( chronic sinusitis )
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| *Supraglottitis
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| *[[Tracheal stenosis]]
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| *[[Tracheobronchitis]]
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| *[[Tracheobronchomegaly]]
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| *Tracheobronchopathia osteoplastica : a rare, benign condition and is characterized by the presence of bony and cartilaginous nodules in the tracheal and bronchial mucosa.
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| *[[Tracheomalacia]]
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| *[[Tuberculosis]], Pulmonary
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| *Vascular compression and rings ( Aberrant subclavian artery abnormality )
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| *Vocal cord dysfunction
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| *Vocal cord hematoma
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| *Vocal cord paralysis (bilateral paralysis)
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| *[[Wegener's granulomatosis]]
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| ===Complete Differential Diagnosis of the Causes of Wheeze===
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| (By organ system)
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| {|style="width:75%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | Cardiac asthma ( pulmonary edema), [[Cardiomegaly]], Descending aortic [[aneurysm]], [[Pulmonary edema]]
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| [[Pulmonary embolism]], Right sided aortic arch, Vascular compression/ rings, [[Heart failure]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| Dialyzer hypersensitivity syndrome, [[Food allergies]], [[Peanut Allergy]], Chemical poisoning
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| Medication-induced bronchoconstriction, [[ACE inhibitors]], [[Sotalol]]
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| ,[[Adenosine]], [[Beta blockers]], [[Dipyridamole]], [[Protamine]], [[NSAIDs]], [[Aspirin]], [[Marijuana]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| [[Aspiration]](foreign particles or foods), Bilateral vocal cord paralysis, Hypertrophied [[tonsils]], Intrathoracic [[goiter]], [[Laryngeal edema]], [[Laryngocele]], Laryngostenosis, [[Laryngotracheobronchitis]], Mobile supraglottic soft tissue, Paroxysmal vocal cord motion, Postextubation [[granuloma]], Postlobectomy bronchial torsion, Postnasal drip syndrome, Postradiation [[stenosis]], [[Retropharyngeal abscess]], Supraglottitis, Vocal cord dysfunction, Vocal cord hematoma, [[Sinusitis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| Intrathoracic [[goiter]], Obesity,
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| [[asthma]], [[Byssinosis]], [[Hay fever]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| [[Gastroesophageal Reflux Disease]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| [[Cystic fibrosis]], [[Milk allergy]], Obesity, [[Primary ciliary dyskinesia]], Vascular compression/ rings, [[Alpha 1-Antitrypsin Deficiency]], [[Ciliary dyskinesia]]-bronchiectasis,
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| [[Lymphadenopathy]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| [[Aspiration]](foreign particles or foods), Esophageal foreign body, [[Mendelson's syndrome]] (aspiration pneumonitis),
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| [[Allergic bronchopulmonary aspergillosis]], Cold induced [[wheezing]], [[Bronchitis]], [[Bronchiolitis]], [[pneumonia]], [[Lymphadenopathy]], [[Retropharyngeal abscess]], [[Tuberculosis]], [[Ascariasis]], [[Hookworm]], Paragonimiases - lung infection, [[Strongyloidiasis]], [[Toxocariasis]], [[Aspergillosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| Cricoarytenoid arthritis,
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| Obesity
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Carcinoid syndrome]], [[Lymphadenopathy]], Lymphangitic carcinomatosis, [[Malignancy]] (bronchogenic tumors), Bronchial adenomata syndrome, [[Mastocytosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| chemical poisoning
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| [[Psychogenic]] wheezing
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| [[Bronchiectasis]], [[Bronchiolitis]], [[Bronchiolitis obliterans]], [[Bronchitis]], [[Bronchopulmonary dysplasia]], [[Carcinoid syndrome]], [[Chronic obstructive pulmonary disease]]: Chronic bronchitis and Emphysema, Cold induced [[wheezing]], [[Cystic fibrosis]], Pulmonary [[hemorrhage]], [[pneumonia]], [[Interstitial lung disease]], Postlobectomy bronchial torsion, Postradiation [[stenosis]], [[Primary ciliary dyskinesia]], [[Pulmonary edema]], [[Pulmonary embolism]], [[Tracheal stenosis]], [[Tracheobronchitis]], [[Tracheobronchomegaly]], [[Tracheomalacia]], [[Wegener's granulomatosis]], [[Pulmonary eosinophilia]], [[Tuberculosis]], [[Alpha 1-Antitrypsin Deficiency]], Extrinsic allergic alveolitis, Bronchial adenomata syndrome, [[Ciliary dyskinesia]]-bronchiectasis, Tracheobronchopathia osteoplastica, [[Aspergillosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[Allergic bronchopulmonary aspergillosis]], [[Anaphylaxis]], [[Angioedema]], [[Asthma]], Cricoarytenoid arthritis, [[Immunodeficiency]], [[Interstitial lung disease]], [[Lymphadenopathy]], [[Milk allergy]], [[Relapsing polychondritis]], [[Wegener's granulomatosis]], [[Pulmonary eosinophilia]], Extrinsic allergic alveolitis, [[Graft-versus-host disease]], [[Hay fever]], [[Mastocytosis]],
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|
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| Amyloid deposition, Tracheobronchopathia osteochondroplastica
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| |-
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| |}
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| [[Image:Asthma before-after.png|thumb|center|350px|'''Inflamed airways and bronchoconstriction in asthma'''. Airways narrowed as a result of the inflammatory response cause wheezing.]]
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| ==Treatment of Wheeze== | | ==Treatment of Wheeze== |
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