The airway narrowing may be caused by bronchoconstriction, mucosal edema, external compression, or partial obstruction by a tumor, foreign body, or tenacious secretions. Wheezing may result from localized or diffuse airway narrowing or obstruction from the level of the larynx to the small bronchi. General (relating to the overall course of asthma in an individual): The clinician should inquire about the following: A careful, thorough history is fundamental not only in arriving at an accurate diagnosis but also in determining the severity of an individual's asthma and its appropriate therapy. It should be highly suspected from a description of episodic and variable respiratory symptoms (with or without wheezing) or recurrent chest colds and bronchitis (productive cough). The diagnosis of asthma is usually obvious from the patient's history. Thus, any patient with chronic or episodic respiratory symptoms or who presents with a history of asthma or other chronic airway disease should be asked about wheezing. Most patients with asthma complain more frequently about chest tightness (in combination with shortness of breath or cough) than wheezing. Some patients with chronic asthma may become accustomed to wheezing and do not volunteer this information unless specifically asked. Nevertheless, wheezing is not always present during active asthma, and its absence should not exclude the diagnosis. The majority of asthmatic patients who report active wheezing generally have this finding documented by the examining physician. Some patients report noisy, difficult breathing (wheezy dyspnea), whereas others describe a whistling type of breathing or rattling secretions in the throat. Wheezing is a subjective complaint that may be described in various ways. A generally accepted definition of asthma does not yet exist because the syndrome has different causes, mechanisms, clinical features, and responses to therapy. The resulting airflow obstruction may be chronic or episodic, with respiratory symptoms resolving either spontaneously or as a result of therapy (bronchodilators or corticosteroids). The syndrome is characterized by wheezing, chest tightness, dyspnea, and/or cough, and results from widespread contraction of tracheobronchial smooth muscle (bronchoconstriction), hypersecretion of mucus, and mucosal edema, all of which narrow the caliber of the airways. A wheeze is synonymous with a high-pitched or sibilant rhonchus.Īsthma is a heterogeneous syndrome characterized by variable, reversible airway obstruction and abnormally increased responsiveness (hyperreactivity) of the airways to various stimuli. A wheeze is a high-pitched, musical, adventitious lung sound produced by airflow through an abnormally narrowed or compressed airway(s).
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