View source for Wheeze

{{short description|Coarse whistling sound from breathing}}
{{Distinguish|Weeze}}
{{Redirect|Wheezing|the Pokémon|Weezing}}
{{Infobox medical condition (new) 
| name            = Wheezing 
| synonyms        = Sibilant rhonchi
| image           = Wheeze2O noise reduced.ogg
| caption         = The sound of wheezing as heard with a [[stethoscope]]
| field           = [[Pulmonology]]
| symptoms        = 
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| causes          = [[virus]], [[bacteria]], [[common cold]], [[allergy]], [[pneumonia]], [[asthma]], [[tuberculosis]]
| risks           = 
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}}

A '''wheeze''' is a clinical symptom of a continuous, coarse, whistling sound produced in the respiratory [[airway]]s during breathing.<ref>{{cite journal | vauthors = Sengupta N, Sahidullah M, Saha G | title = Lung sound classification using cepstral-based statistical features | journal = Computers in Biology and Medicine | volume = 75 | issue = 1 | pages = 118–129 | date = August 2016 | pmid = 27286184 | doi = 10.1016/j.compbiomed.2016.05.013 }}</ref> For wheezes to occur, part of the respiratory tree must be narrowed or obstructed (for example narrowing of the lower respiratory tract in an asthmatic attack), 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]], though it can also be a symptom of [[lung cancer]], [[congestive heart failure]], and certain types of [[heart disease]]s.

The [[differential diagnosis]] of wheezing is wide, and the reason for  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 term "wheeze" is also used as a clinical condition describing wheezing in preschool children, termed as "preschool wheeze".<ref name="Van Bever 2010">{{cite journal | vauthors = Van Bever HP, Han E, Shek L, Yi Chng S, Goh D | title = An approach to preschool wheezing: to label as asthma? | journal = The World Allergy Organization Journal | volume = 3 | issue = 11 | pages = 253–257 | date = November 2010 | pmid = 23282943 | pmc = 3651058 | doi = 10.1097/WOX.0b013e3181fc7fa1 }}</ref>

== Clinical symptom ==
=== Wheeze ===
Wheezes occupy different portions of the [[respiration (physiology)|respiratory]] cycle depending on the site of airway obstruction and its nature. The fraction of the respiratory cycle during which a wheeze is produced roughly corresponds to the degree of airway obstruction.<ref>{{cite journal | vauthors = Baughman RP, Loudon RG | title = Quantitation of wheezing in acute asthma | journal = Chest | volume = 86 | issue = 5 | pages = 718–722 | date = November 1984 | pmid = 6488909 | doi = 10.1378/chest.86.5.718 }}</ref><ref>{{cite journal | vauthors = Pasterkamp H, Tal A, Leahy F, Fenton R, Chernick V | title = The effect of anticholinergic treatment on postexertional wheezing in asthma studied by phonopneumography and spirometry | journal = The American Review of Respiratory Disease | volume = 132 | issue = 1 | pages = 16–21 | date = July 1985 | pmid = 3160273 | doi = 10.1164/arrd.1985.132.1.16 | doi-broken-date = 1 November 2024 }}</ref> [[Bronchiole|Bronchiolar]] disease usually causes wheezing that occurs in the expiratory phase of respiration. As a rule, extrathoracic airway obstruction produce inspiratory sounds. Intrathoracic major airway obstruction produces inspiratory as well as expiratory sounds. Distal airway obstruction predominantly produces expiratory sounds.<ref>{{Cite book|title=Essential Pediatrics|last=Ghai|first=OP|publisher=CBS Publishers & Distributors|year=2014|isbn=978-81-239-2334-5|pages=372}}</ref>

The presence of expiratory phase wheezing signifies that the patient's [[Spirometry|peak expiratory flow rate]] is less than 50% of normal.<ref>{{cite journal | vauthors = Shim CS, Williams MH | title = Relationship of wheezing to the severity of obstruction in asthma | journal = Archives of Internal Medicine | volume = 143 | issue = 5 | pages = 890–892 | date = May 1983 | pmid = 6679232 | doi = 10.1001/archinte.143.5.890 }}</ref> Wheezing heard in the inspiratory phase, on the other hand, is often a sign of a stiff stenosis, usually caused by [[tumor]]s, foreign bodies or scarring. This is especially true if the wheeze is [[monophony|monotonal]], occurs throughout the inspiratory phase (i.e. is "holoinspiratory"), and is heard more proximally, in the [[Vertebrate trachea|trachea]]. Inspiratory wheezing also occurs in hypersensitivity pneumonitis.<ref>{{cite journal | vauthors = Earis JE, Marsh K, Pearson MG, Ogilvie CM | title = The inspiratory "squawk" in extrinsic allergic alveolitis and other pulmonary fibroses | journal = Thorax | volume = 37 | issue = 12 | pages = 923–926 | date = December 1982 | pmid = 7170682 | pmc = 459459 | doi = 10.1136/thx.37.12.923 }}</ref> Wheezes heard at the end of both expiratory and inspiratory phases usually signify the periodic opening of deflated [[pulmonary alveolus|alveoli]], as occurs in some diseases that lead to collapse of parts of the [[lung]]s.

The location of the wheeze can also be an important clue to the diagnosis. Diffuse processes that affect most parts of the lungs are more likely to produce wheezing that may be heard throughout the [[chest]] via a stethoscope. Localized processes, such as the occlusion of a portion of the respiratory tree, are more likely to produce wheezing at that location, hence the sound will be loudest and radiate outwardly. The pitch of a wheeze does not reliably predict the degree of narrowing in the affected airway.<ref>{{cite journal | vauthors = Meslier N, Charbonneau G, Racineux JL | title = Wheezes | journal = The European Respiratory Journal | volume = 8 | issue = 11 | pages = 1942–1948 | date = November 1995 | pmid = 8620967 | doi = 10.1183/09031936.95.08111942 | doi-access = free }}</ref>

=== Stridor ===
A special type of wheeze is [[stridor]]. Stridor — the word is from the Latin, ''strīdor''<ref>Simpson JA, Weiner ESC (eds). "''stridor, n. 2''." ''Oxford English Dictionary'' 2nd ed. Oxford: Clarendon Press, 1989. OED Online Oxford University Press. Accessed September 10, 2005. http://dictionary.oed.com {{Webarchive|url=https://web.archive.org/web/20060625103623/http://dictionary.oed.com/ |date=2006-06-25 }}.</ref> — is a harsh, high-pitched, vibrating sound that is heard in respiratory tract obstruction. Stridor heard solely in the inspiratory phase of respiration usually indicates an upper respiratory tract obstruction, "as with aspiration of a foreign body (such as the fabled pediatric peanut)."<ref>{{cite book |vauthors=Sapira JD, Orient JM |title=Sapira's art & science of bedside diagnosis |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2000 |isbn=978-0-683-30714-6 |edition=2nd }}</ref> 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. Biphasic stridor (occurring during both the inspiratory and expiratory phases) indicates narrowing at the level of the [[glottis]] or [[subglottis]], the point between the upper and lower airways.

==Preschool wheeze==
Preschool wheezing is a clinical condition that describes wheezing preschool children that do not fulfill the criteria of "[[asthma]]" fully as asthma would require a person to demonstrate a history of at least three episodes of [[exacerbation]]s (worsening of symptoms) or chronic cough or wheeze for the past six months.<ref name="Van Bever 2010"/> Besides, a number of wheezing preschool children would have their symptoms resolved after they had grown up, unlike asthma which persists into adulthood. Preschool wheezing can be divided into "viral-induced wheeze" and "multi-trigger wheeze". Viral-induced wheezing accounts for about two-thirds of all preschool wheezes. The wheezing symptom is episodic and the child is completely normal in between wheezing episodes. It has a good prognosis and only supportive treatment is required. Meanwhile, multi-trigger wheezing is associated with allergy and a family history of asthma. Symptoms occur in between wheezing episodes and are likely to persist beyond early childhood. Due to difficulty in differentiating both types of wheeze, the diagnosis of viral-induced versus multi-trigger wheeze may be delayed for a period of time until its clinical course has become clear.<ref name="Van Bever 2010"/>

==To wheeze (slang) ==
'''To wheeze''' implies an inability to speak clearly, so in politics it refers to an [[Heterodoxy|unorthodox]] or less than [[ethical]] maneuver that is not actually illegal, but relies on an element of deception or sleight of hand, being an intermediate between a [[workaround]] and a [[scam]].<ref>[https://forum.wordreference.com/threads/wheeze.1006933/ Word Reference Wheeze Accessed 02 July 2024]</ref>

In this context ''wheezing'' is notably linked with the slang expression ''Joe Blow'' meaning any external person or group beyond a secretive [[fraternity]].<ref>[https://www.vocabulary.com/dictionary/Joe%20Blow Vocabulary.com: Joe Blow Accessed 02 July 2024]</ref> (See also [[insider trading]].)

== See also ==
* [[Crackles]] (also called "crepitations" or "rales")
* [[Rhonchi]]
* [[Squawk (sound)]]

== References ==
{{Reflist}}

== Further reading ==
* {{cite journal | vauthors = Godfrey S, Uwyyed K, Springer C, Avital A | title = Is clinical wheezing reliable as the endpoint for bronchial challenges in preschool children? | journal = Pediatric Pulmonology | volume = 37 | issue = 3 | pages = 193–200 | date = March 2004 | pmid = 14966812 | doi = 10.1002/ppul.10434 | s2cid = 25264776 }}

== External links ==
{{Medical resources
|   ICD10       = {{ICD10|R|06|2|r|00}}  
|   ICD9        = {{ICD9|786.07}}  
| DiseasesDB=1715 
|   MedlinePlus = 003070  
}}
* [http://respwiki.com/Breath_sounds Audio Breath Sounds] {{Webarchive|url=https://web.archive.org/web/20201215121532/http://respwiki.com/Breath_sounds |date=2020-12-15 }} - Multiple case studies with audio files of lung sounds.
* [http://www.rale.ca/Recordings.htm R.A.L.E. Repository] - sound files of breath sounds

{{Circulatory and respiratory system symptoms and signs}}

[[Category:Symptoms and signs: Respiratory system]]