Wheezes

A wheeze is a musical, whistling sound produced by turbulent airflow through narrowed airways during breathing. It is most commonly heard during expiration and can sometimes be audible without a stethoscope in moderate to severe obstruction, or detected by chest auscultation in milder cases.

Wheezes are categorized by their quality and timing. Polyphonic wheezes feature multiple pitches and generally indicate diffuse airway narrowing (asthma, COPD), while a monophonic wheeze suggests a single obstructing site (for example, a foreign body or localized lesion).

Common causes include asthma and other inflammatory airway diseases, COPD, viral bronchiolitis, bronchitis, allergic reactions, and less often heart failure or pneumonia. In children, viral-induced wheeze and bronchiolitis are frequent; in adults, wheeze is often related to asthma or COPD.

Diagnosis rests on history and examination, supported by spirometry or peak flow if possible. Distinguish wheezes from rhonchi (coarse, lower-pitched sounds) and from stridor (upper airway obstruction, usually inspiratory). Wheezes are typically expiratory, though inspiratory wheeze can occur with large airway obstruction.

Management targets the underlying cause. Short-acting bronchodilators can relieve symptoms, and corticosteroids may be used for acute or chronic inflammatory disease. Oxygen therapy is given for hypoxemia. In emergency settings, treat severe obstruction and consider imaging and specialist referral.