Wheezing and the Bronchiectasis/NTM Patient

Posted on April 19, 2022   |   
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This blog post was authored by Katie Keating, RN, MS, and reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

Do you occasionally wheeze? Do you become concerned and sometimes confused about the causes of your wheezing? Ongoing wheezing can cause stress and worry to occur. Getting to the root cause of your wheezing may relieve worry and help you to breathe easier.

What is wheezing?

Wheezing is a high-pitched, coarse whistle-like sound made when you breathe. It is the result of air moving through narrowed or partially blocked airways. The breath does not easily move in and out of the lungs.

Many people with respiratory allergies know that wheezing often comes with allergy season. It may also happen because of lung infections like acute bronchitis. But chronic obstructive pulmonary disease (COPD) and asthma are the most common causes.1

Wheezing is never normal. If you notice it when you inhale or exhale, and particularly if it persists or worsens, you should consult a doctor to find out what is restricting your airway.2

Wheezing is more obvious when you breathe out (exhale) but can also be heard when you breathe in (inhale). The tone of the wheeze can vary depending on which part of the respiratory system is blocked or narrowed. Narrowing in the upper respiratory system may make for a hoarser wheeze.3

What causes wheezing?

Many health problems can cause wheezing, some of the most common include the following4:

  • Asthma (a lung condition where the airways narrow, swell, and produce extra mucus, making it hard to breathe)
  • Allergic reactions often to pollen, chemicals, pet dander, dust, foods, or insect stings
  • Bronchitis
  • Bronchiectasis (an abnormal widening of bronchial tubes which inhibits mucus clearing)
  • COPD exacerbation (a worsening of symptoms)
  • Pneumonia (an infection that inflames the air sacs in the lungs and they fill with fluid or pus)
  • Obstruction of an airway by an inhaled object or food particle
  • Bronchiolitis (a lung infection that inflames airways and causes congestion)
  • GERD-related asthma. (Gastroesophageal reflux disease or GERD occurs when acid from the stomach comes back into the esophagus, the tube that connects the stomach to the throat. Chronic GERD is also often associated with asthma, causing wheezing. The two diagnoses often coexist, with each one contributing to the other. Acid reflux can trigger an asthma attack in patients with the condition.5)
  • Postnasal drip. (It is considered to be the cause of wheezing when you hear the wheezing sound when lying down, as opposed to hearing it when sitting up. With postnasal drip, excess mucus in the nose finds its way down the throat into the air passageways. When this occurs, the lungs will start producing wheezing sounds that can be heard without the need for a stethoscope.)
  • Obstructive sleep apnea
  • Smoking

Other accompanying symptoms may include the following: wet cough, headache, fever, malaise, and dry cough.

If you experience ANY of the following symptoms, you should seek immediate care from your health care team or go to the emergency room.

  • pain when inhaling or exhaling
  • chest pains
  • excessive sweating
  • trouble catching your breath
  • rapid breathing
  • purple or blue lips
  • tightness in the chest
  • coughing up phlegm or blood
  • pale skin
  • hoarse voice
  • confusion5

Diagnosing the cause of wheezing

Your doctor will ask questions such as:

  • How long have you been wheezing?
  • Does it happen when you exercise? Does rest help control it?
  • Do you wheeze more during the day, or at night?
  • Do you wheeze when you breathe in, or out, or both in and out?
  • Do you smoke?
  • Do certain foods/drinks seem to cause your wheezing?

Doctors will listen to your breathing and the sounds your lungs make. They may order a chest x-ray, pulmonary function tests, sputum cultures, and other diagnostic tests depending upon your personal history and physical exam.

How is wheezing treated?

Treatment depends on the cause.

To treat wheezing caused by asthma, your doctor may prescribe a bronchodilator medication to ease inflammation and open your airways, inhaled corticosteroids to fight inflammation, and antihistamines to prevent asthma and allergy symptoms.

To treat GERD-related asthma, changes in your diet may be recommended like avoiding coffee or acidic foods like tomatoes. Eating smaller meals and avoiding eating late in the day may also help. It is important to speak with your healthcare provider about recommendations for medications that may relieve your symptoms.6

For wheezing associated with bronchitis, your practitioner may prescribe a bronchodilator to open your airways and an antibiotic to fight a bacterial infection.

Below are a few suggestions to help relieve or prevent wheezing:

  • Drink something warm. It relaxes your airways and loosens sticky mucus.
  • Take your medicines according to the instructions.
  • Don’t smoke and avoid second-hand smoke.
  • Do breathing exercises to help your lungs work better.
    • Pursed-lip breathing. Breathe in through your nose. Breathe out for twice as long, with your lips pursed like you’re going to whistle.
    • Belly breathing. Breathe in through your nose. Put your hands on your belly and pay attention to how it expands. Breathe out through your mouth for at least two to three times as long as you breathed in.
  • Clean the air. Use an air purifier with a HEPA filter to cut down on allergens that often lead to asthma attacks.

Getting to the root cause of wheezing is extremely important. Symptoms of several disorders, such as asthma, reflux, postnasal drip, and allergies often overlap and may lead to a misdiagnosis and improper treatment. You may need to keep a journal of your symptoms and of your visits to multiple specialists (allergists, pulmonologists, gastroenterologists) before you can get the right diagnosis and appropriate treatment. Quality of life is everything. Keep fighting for the relief you seek . . . and deserve.


References:

  1. https://www.webmd.com/asthma/understanding-wheezing-basics
  2. https://www.verywellhealth.com/what-causes-wheezing-201235
  3. https://my.clevelandclinic.org/health/symptoms/15203-wheezing
  4. https://www.mayoclinic.org/symptoms/wheezing/basics/causes/sym-20050764
  5. https://www.treatmd.org/health/how-to-stop-wheezing-when-lying-donw/
  6. https://www.everydayhealth.com/asthma/symptoms/surprising-connection-between-gerd-asthma/