Wheezing of Baby/ Child; Treatment, Complication

Wheezes are defined as high-pitched, continuous, adventitious lung sounds. They are produced by the oscillation of opposing airway walls whose lumen is narrowed. Although asthma is the most common cause of wheezing, a wide variety of disease processes may result in wheezing due to airway obstruction. This obstruction may be caused by airway edema?, smooth muscle constriction, increased secretions, vascular congestion, mass lesions, scarring, or foreign bodies. Stridor is a special kind of wheeze described as a loud musical sound of the constant pitch, which is heard in patients with tracheal or laryngeal obstruction. The full diagnosis?: Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।" data-rx-term="differential diagnosis" data-rx-definition="Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।">differential diagnosis? of airway obstruction should be carefully considered in any patient with wheezing or stridor.

A wheeze is a high-pitched, musical, adventitious lung sound produced by airflow through an abnormally narrowed or compressed airway(s). A wheeze is synonymous with a high-pitched or sibilant rhonchus.

Types of Wheezing

Stridor

A special type of wheeze is stridor. Stridor – the word is from the Latin, strīdor^[rx] — 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).”^[rx] 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.

Causes of Wheezing

Since any process that reduces airway caliber generates wheeze, below are some of the many of the conditions that can cause wheeze

• Asthma – This condition, in which your airways narrow, swell, and make extra mucus, can make it hard to breathe.
• Allergic reactions – to pollen, chemicals, pet dander, dust, foods, or insect stings
• Acute or chronic bronchitis and COPD – which can produce excess mucus in the respiratory tract and cause the lungs’ passageways to become blocked
• Pneumonia – An infection? that inflames the air sacs in your lungs, and they fill with fluid or pus
• Bronchiolitis –This lung infection? that inflames the airways and causes congestion usually affects children.
• Emphysema – a lung condition that causes shortness of breath
• Smoking, or breathing in smoke – can make you wheeze.
• Respiratory syncytial virus – This virus can lead to bronchiolitis, a lung infection? that inflames the airways and causes congestion or pneumonia.
• Cystic chronic? injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।" data-rx-term="fibrosis" data-rx-definition="Fibrosis means excess scar-like tissue formation after chronic injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।">fibrosis? – an inherited disease that damages your lungs and makes the mucus extra sticky and thick
• Obstruction of an airway – by a foreign body that has been inhaled (such as a coin)
• Panic – A panic attack can cause a person’s throat to tighten and make breathing difficult.
• Bronchitis – Bronchitis is an infection?, or irritation, often causing pain?, swelling?, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation? of the bronchial tubes that are often caused by a viral? or bacterial? infection.
• Cold and flu – Infections that cause the common cold or flu can cause infection?, or irritation, often causing pain?, swelling?, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation? and breathing problems.
• Pneumonia – Pneumonia is an infection? of the lungs.
• Tumor in the lungs
• Congestive heart failure
• Respiratory infections (croup, laryngitis)
• Obstructive airway diseases (asthma,
• chronic? obstructive pulmonary disease, anaphylaxis?, bronchiolitis)
• Pulmonary peribronchial edema? (congestive heart failure)
• Vocal cord dysfunction (paradoxical vocal fold motion, vocal cord paralysis)
• Postnasal drip
• Airway compression: Intrinsic or extrinsic (squamous cell carcinomas, goiter?)
• Hyperdynamic airway collapse (tracheobronchomalacia)
• Carcinoid tumors
• Foreign body inhalation
• Forced exhalation by normal individuals[rx][rx][rx]
• Emphysema
• Gastroesophageal reflux disease (GERD)
• Heart failure
• Epiglottitis (swelling? of the “lid” of your windpipe)
• Lung cancer
• Medications (particularly aspirin)
• Sleep apnea, obstructive (a condition in which breathing stops and starts during sleep)
• Pneumonia
• Respiratory syncytial virus (RSV) — especially in young children
• Respiratory tract infection? (especially in children younger than 2)
• Smoking
• Vocal cord dysfunction (a condition that affects vocal cord movement)
• Lung cancer
• Sleep apnea
• Vocal cord dysfunction
• Bronchitis
• Pneumonia
• Respiratory tract infection?
• Reaction to smoking
• Inhaling a foreign object
• Anaphylaxis?
• Bronchiolitis, a viral? respiratory infection?

Symptoms of Wheezing

• Shortness of breath after exertion or due to a medical condition
• Feeling smothered or suffocated as a result of breathing difficulties
• Labored breathing
• Tightness in the chest
• Rapid, shallow breathing
• Heart palpitations
• Coughing
• Clearly audible, loud, labored breathing
• An anxious, distressed facial expression
• Flaring nostrils
• Protrusion of the abdomen and/or chest
• Gasping
• Cyanosis? (pale or blue face, mouth, lips, or extremities)
• Anxiousness,
• Bloody sputum,
• Chest injury
• Chest pain?,
• Chest tightness
• Cough
• Dizziness
• Fainting,
• Fatigue
• Heart palpitations,
• Labored breathing,
• Neck pain,
• Pain? with inspiration (pleurisy)

Diagnosis? of Wheezing

Other tests you might have include

• Pulse oximetry  – a device is clipped to your finger or ear lobe, and a light on it measures how much oxygen is in your blood.
• Blood tests, including a complete blood count (CBC) – to see if you have anemia? (when your body doesn’t make enough red blood cells) or infection? and other tests to check for a blood clot or fluid in your lungs.
• Chest X-ray or a computerized tomography (CT) scan – to see if you have pneumonia, blood clot in your lung, or another lung disease. A CT scan puts several X-rays taken from different angles together to make a more complete picture.
• Electrocardiogram (ECG) –  to measure the electrical signals from your heart to see if you’re having a heart attack and find out how fast your heart is beating and if it has a healthy rhythm.
• Patients should be tested for electrolyte abnormalities – endocrine disorders (specifically hyperthyroid) drug-induced causes, infections, drug or chemical withdrawal, and echocardiography to check for structural heart disease. In patients presenting with ischemic stroke and with no prior history of AF, 72-hour Holter monitoring improves the detection rate of silent paroxysmal.[rx]
• Screening spirometry – Can assess how much air you can breathe
• Complete pulmonary function testing – Can evaluate your breathing capabilities in more detail than screening spirometry by measuring how much air you can breathe in and out, as well as how quickly
• Arterial blood gas measurement – Provides a measure of the oxygen content of your blood, which alerts your doctors if you are becoming low in oxygen
• Echocardiography – May be ordered if your EKG suggests that you have heart disease
• Standard exercise treadmill testing – Evaluates your breathing when you have increased oxygen demands
• Complete cardiopulmonary exercise testing – Evaluates your heart and lung function in detail

Treatment of Wheezing

Initial Stage

An important step in managing shortness of wheezing the cause, such as the tumor or a blood clot/ COPD. The doctor may also recommend the following to help relieve your symptoms

• Receiving extra oxygen
• Sitting in front of a fan
• Breathing cooler air by lowering the temperature in a room
• Breathing cleaner air by opening a window, using a humidifier, or getting rid of smoke and pet dander
• Getting a sense of open space by seeing a view of the outside, opening windows, or being in an empty room
• Keeping your head lifted, for example, by using pillows so that you are nearly sitting
• Practicing techniques that take your focus away from the problem, such as relaxation and meditation
• Bronchodilator to open your airways
• Clean the air – Use an air cleaner with a HEPA filter. This will help cut down on allergens that often lead to asthma attacks.
• Try breathing exercises – They can help your lungs work better, which helps with asthma symptoms like wheezing. Try these:
  • Pursed lip breathing – Breathe in through your nose, and breathe out twice as long, with your lips pursed.
  • Belly breathing – Breath in through your nose. Pay attention to how your belly fills with air (put your hands on it). Breathe out through your mouth for at least 2 to 3 times as long as you breathed in.

Steam inhalation

Inhaling warm, moisture-rich air can be very effective for clearing the sinuses and opening up the airways.

To do this, a person can use the following method:

• Pour hot water into a large bowl and breathe in the steam.
• Place a towel over the head to trap extra moisture.
• Add a few drops of menthol or eucalyptus oil to the water to make the stream more powerful.

Peppermint essential oil may have pain-relieving and anti-inflammatory effects. Research from 2013[rx]suggests that it may relax the muscles of the respiratory system, which could help to relieve wheezing and other respiratory problems. Peppermint essential oils can be purchased from drug stores or online[rx]. If a steam bath does not appeal to you, a sauna room or hot shower can also help loosen congestion. Gently tapping on the back or chest and breathing deeply can help the steam work even better.

Hot drinks

Warm and hot drinks can help to loosen up the airways and relieve congestion. Honey is a natural anti-inflammatory and antimicrobial, so adding a teaspoon of honey to a hot drink may further improve a person’s symptoms. A 2017 study[rx] found that eating one tablespoon of honey twice a day, along with other treatments, helped to relieve throat congestion. Some people find that peppermint or other menthol teas work well. A person can try experimenting with different teas to find one that helps.

Breathing exercises

Breathing exercises may help with COPD, bronchitis, allergies, and other common causes of wheezing. A 2009 study[rx] found that certain yoga-inspired breathing techniques could help with breathing difficulties related to bronchial asthma, including wheezing. Breathing exercises often include deep, regular inhalations and exhalations. A doctor or respiratory therapist can help with deciding the most effective breathing techniques. A person may find that they have trouble breathing during a panic attack. Deep breathing exercises can also assist here. It may help to try slow breathing, focusing on breathing deeply into the stomach, and counting breathes.

Humidifiers

Air filters

Many conditions that cause wheezing can get worse when the air is polluted or in response to allergens. A home air filter can reduce the presence of irritants that may trigger wheezing and breathing trouble.

Identifying and removing triggers

Chronic illnesses such as asthma and allergies may get worse in response to certain triggers, such as stress or allergens. Controlling these triggers, as much as possible, can help. For instance, a person with a chronic respiratory condition who also has allergies might take allergy medication and avoid allergy triggers.

Allergy medications

People with allergies can benefit from a wide variety of allergy medications, including decongestants, corticosteroid tablets, and antihistamines. Nasal sprays may be especially helpful to relieve a tight chest, congestion, and inflammation that can cause wheezing. More severe allergies may require prescription allergy medication.

Allergy immunotherapy

Immunotherapy is a process of retraining the immune system not to react to allergens. The most common form of immunotherapy is allergy shots. A person may need several treatments, but over time, immunotherapy can reduce the frequency of wheezing. Immunotherapy may also be helpful for people with other chronic conditions, such as COPD, who also have allergies. Breathing exercises for people with COPD. There are several breathing exercises that can help people with COPD relieve respiratory symptoms. Learn about them here.

Bronchodilators

Bronchodilators are medications that help relax the lungs and prevent the airways from narrowing. They can help with wheezing caused by COPD and asthma.

Bronchodilators come in two forms:

• Short-acting bronchodilators – Sometimes known as rescue inhalers, these can stop asthma or COPD attack.
• Long-acting bronchodilators – This variety helps relax the airways over the long-term, reducing the frequency and severity of wheezing episodes.

Bronchodilators should be obtained from a doctor and can then be used at home, as needed.

Other medications

A wide variety of medications can treat wheezing that is due to an underlying illness. A person who experiences wheezing due to a severe allergic reaction, for instance, may require epinephrine or corticosteroids. People with heart health issues may take blood pressure medication or blood thinners to prevent further damage to the heart. It is vital to discuss with a doctor whether medication might help, and how various medications may interact with one another.

References