Wheeze

Clinical symptom

Wheeze

Wheezes occupy different portions of the 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. 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.

The presence of expiratory phase wheezing signifies that the patient's peak expiratory flow rate is less than 50% of normal. Wheezing heard in the inspiratory phase, on the other hand, is often a sign of a stiff stenosis, usually caused by tumors, foreign bodies or scarring. This is especially true if the wheeze is monotonal, occurs throughout the inspiratory phase (i.e. is "holoinspiratory"), and is heard more proximally, in the trachea. Inspiratory wheezing also occurs in hypersensitivity pneumonitis. Wheezes heard at the end of both expiratory and inspiratory phases usually signify the periodic opening of deflated alveoli, as occurs in some diseases that lead to collapse of parts of the lungs.

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.

Stridor

A special type of wheeze is stridor. Stridor — the word is from the Latin, strīdor — 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)." 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 exacerbations (worsening of symptoms) or chronic cough or wheeze for the past six months. 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.

To wheeze (slang)

To wheeze implies an inability to speak clearly, so in politics it refers to an 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.

In this context wheezing is notably linked with the slang expression Joe Blow meaning any external person or group beyond a secretive fraternity. (See also insider trading.)

References

References

1. (August 2016). "Lung sound classification using cepstral-based statistical features". Computers in Biology and Medicine.
2. (November 2010). "An approach to preschool wheezing: to label as asthma?". The World Allergy Organization Journal.
3. (November 1984). "Quantitation of wheezing in acute asthma". Chest.
4. (July 1985). "The effect of anticholinergic treatment on postexertional wheezing in asthma studied by phonopneumography and spirometry". The American Review of Respiratory Disease.
5. Ghai, OP. (2014). "Essential Pediatrics". CBS Publishers & Distributors.
6. (May 1983). "Relationship of wheezing to the severity of obstruction in asthma". Archives of Internal Medicine.
7. (December 1982). "The inspiratory "squawk" in extrinsic allergic alveolitis and other pulmonary fibroses". Thorax.
8. (November 1995). "Wheezes". The European Respiratory Journal.
9. 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. link. (2006-06-25 .)
10. (2000). "Sapira's art & science of bedside diagnosis". Lippincott Williams & Wilkins.
11. [https://forum.wordreference.com/threads/wheeze.1006933/ Word Reference Wheeze Accessed 02 July 2024]
12. [https://www.vocabulary.com/dictionary/Joe%20Blow Vocabulary.com: Joe Blow Accessed 02 July 2024]