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Wheezing

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What is wheezing ?

Wheezing: is characterized by a loud high pitched whistle like noise which is heard on exhalation/ expiration (breathing out) through inflamed and narrowed airways. It can also be heard during inhalation/ inspiration (breathing in) but is not very prominent.

How does it all happen?

• There is inflammation of the bronchial tubes lining through which the air passes to and fro from the lungs.

• Primary cause is due to narrowing of the airways which can be secondary to many causes mainly being a chronic respiration condition like asthma or heart failure.

Causes:

• Environmental stimuli: Smoking and Passive smoking both can cause wheezing. Then environmental factors like air pollution, allergens, pets or dust particles, can cause wheezing.

• Accompanied with diseases like, asthma, COPDs, Cystic Fibrosis, lung cancer, pneumonia and respiratory syncytial viruses.

• GERD

• Sleep apnea

• Vocal cord dysfunction

• Bronchiolitis

• Bronchitis

• Foreign body inhalation

• Heart failure

• Inflammation of the epiglottis

• Emphysema and bronchiectasis

• In children: tracheaoesohpgeal fistula, cystic fibrosis, bronchiolitis, GERD, disorders of swallowing, Bronchopulmonary dysplasia, bronchiolitis, diaphragmatic hernia, airway compression by vascular rings or bronchogenic cyst, any chronic lung disease like asthma and due to mediastinal masses. Low maternal vitamin D status in late pregnancy, maternal obesity, folic acid supplementation during late pregnancy and reduced maternal iron profile has shown to be associated with wheezing in children.

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Symptoms:

• Cough

• Difficulty in breathing

• Tightness of chest

• Stuffy nose

• Loss of voice

Alarming signs:

• If fever is higher than 100.4 F/ 38OC.

• Bluish discoloration of fingers, skin or nails (cyanosis) which occurs secondary to decreased oxygen levels.

• Recurrent without any obvious cause

Complications:

• If proper care and treatment is not taken, then there can be worsening of the wheezing.

• Associated with Increased respiratory symptoms and severe health related quality of life (HRQoL).

• It can cause altered mental status.

• It can aid in spreading a pre existing infection or malignancy.

Diagnosis:

• Proper Patient history: it is most essential to know the triggering factors, when it happens (day/night), personal history of smoking or any allergies and how often it happens.

Prevention:

• Avoid cigarette smoke. Quit cigarette smoking and avoid being a passive smoker as well.

• Keep air moist

• Vaccines: Getting a flu vaccine to prevent influenza and virus and vaccine to prevent certain types of pneumonia.

• Increase intake of warm liquids/ drinks.

• Use air purifiers: prevent allergens and provide better air quality around you.

Treatment:

• Cessation of smoking.

• Including Pulmonary rehabilitation like chest physiotherapy, flutter valve and high frequency chest wall oscillators.

• Bronchodilators (short and long acting)

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