Wheeze

A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing.[1] For wheezes to occur, some 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 diseases.

Not to be confused with Weeze.
Wheezing
Other namesSibilant rhonchi
The sound of wheezing as heard with a stethoscope
SpecialtyPulmonology

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.

Characteristics

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.[2][3] 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.[4]

The presence of expiratory phase wheezing signifies that the patient's peak expiratory flow rate is less than 50% of normal.[5] 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.[6] 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.[7]

Stridor

A special type of wheeze is stridor. Stridor — the word is from the Latin, strīdor[8] — 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)."[9] 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.

gollark: It also does have the whole "anything which implements the right functions implements an interface" thing, which seems very horrible to me as a random change somewhere could cause compile errors with no good explanation.
gollark: - `make`/`new` are basically magic- `range` is magic too - what it does depends on the number of return values you use, or something. Also, IIRC user-defined types can't implement it- Generics are available for all of, what, three builtin types? Maps, slices and channels, if I remember right.- `select` also only works with the built-in channels- Constants: they can only be something like four types, and what even is `iota` doing- The multiple return values can't be used as tuples or anything. You can, as far as I'm aware, only return two (or, well, more than one) things at once, or bind two returns to two variables, nothing else.- no operator overloading- it *kind of* has exceptions (panic/recover), presumably because they realized not having any would be very annoying, but they're not very usable- whether reading from a channel is blocking also depends how many return values you use because of course
gollark: What, you mean no it doesn't have weird special cases everywhere?
gollark: It pretends to be "simple", but it isn't because there are bizarre special cases everywhere to make stuff appear to work.
gollark: So of course, lol no generics.

See also

References
  1. Sengupta, Nandini; Sahidullah, Md; Saha, Goutam (August 2016). "Lung sound classification using cepstral-based statistical features". Computers in Biology and Medicine. 75 (1): 118–129. doi:10.1016/j.compbiomed.2016.05.013. PMID 27286184.
  2. Baughman RP, Loudon RG (Nov 1984). "Quantitation of wheezing in acute asthma". Chest. 86 (5): 718–22. doi:10.1378/chest.86.5.718. PMID 6488909.
  3. Pasterkamp H, Tal A, Leahy F, Fenton R, Chernick V (Jul 1985). "The effect of anticholinergic treatment on postexertional wheezing in asthma studied by phonopneumography and spirometry". The American Review of Respiratory Disease. 132 (1): 16–21. doi:10.1164/arrd.1985.132.1.16 (inactive 2020-05-21). PMID 3160273.
  4. Ghai, OP (2014). Essential Pediatrics. CBS Publishers & Distributors. p. 372. ISBN 978-81-239-2334-5.
  5. Shim CS, Williams MH (May 1983). "Relationship of wheezing to the severity of obstruction in asthma". Archives of Internal Medicine. 143 (5): 890–2. doi:10.1001/archinte.143.5.890. PMID 6679232.
  6. Earis JE, Marsh K, Pearson MG, Ogilvie CM (Dec 1982). "The inspiratory "squawk" in extrinsic allergic alveolitis and other pulmonary fibroses". Thorax. 37 (12): 923–6. doi:10.1136/thx.37.12.923. PMC 459459. PMID 7170682.
  7. Meslier N, Charbonneau G, Racineux JL (Nov 1995). "Wheezes". European Respiratory Journal. 8 (11): 1942–8. doi:10.1183/09031936.95.08111942. PMID 8620967.
  8. 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.
  9. Sapira JD, Orient JM (2000). Sapira's art & science of bedside diagnosis (2nd ed.). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 978-0-683-30714-6.

Further reading
  • Godfrey S, Uwyyed K, Springer C, Avital A (Mar 2004). "Is clinical wheezing reliable as the endpoint for bronchial challenges in preschool children?". Pediatric Pulmonology. 37 (3): 193–200. doi:10.1002/ppul.10434. PMID 14966812.
Classification
External resources
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