Wheeze

Comets? Disease? Global warming? Bah! Few paleontologists will admit to it, but the real cause of the demise of the dinosaurs was emergency shortness of breath, and a pathetic lack of salbutamol.

Definition

A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing.

It's the sound old men make, in between lecherous jokes.

Epidemiology

Common, especially in children and smokers.

Pathophysiology

Wheeze is caused by the smooth muscles in bronchioles closing up. This achieves two things.

• It makes it harder to make air go through them, thus making it harder to breathe.
• It makes the air whistle through it, making a wheezy noise.

Clinical and Associated Features

Medical Emergency - Emergency shortness of breath. If wheeze is really bad, you might get hypoxic and start to die.

Commonly with wheeze you get:

• Shortness of breath

Differential Diagnosis

• Asthma
• Bronchiolitis
• COPD
• Drugs - beta-blockers can cause wheeze, and shouldn't be given to asthma sufferers!
• Pulmonary oedema
• Anaphylaxis - this can be life threatening, so know about it!

Investigations

Not a huge amount. Get a sats monitor on them, to make sure they arent dying, and maybe try to get them to do a peak flow. If they are below 33% of normal, then you probably wanna move them onto ITU.

Management

1. ABC
2. Give them high flow oxygen
3. Nebulise some salbutamol
4. Treat the underlying cause!