Contributor: Travis Barlock, MD
Educational Pearls:
- Wheezing is classically heard in asthma and COPD, but it can be the result of a wide range of processes that cause airflow limitation
- Narrowed bronchioles lead to turbulent airflow → creates the wheezing
- Crackles (rales) suggest pulmonary edema which is often due to heart failure
- Approximately 35% of heart failure patients have bronchial edema, which can also produce wheezing
- COPD and heart failure can coexist in a patient, and both of these diseases can cause wheezing
- It’s vital to differentiate whether the wheezing is due to the patient’s COPD or their heart failure because the treatment differs
- Diagnosing wheezing due to heart failure (cardiac asthma):
- Symptoms: orthopnea, paroxysmal nocturnal dyspnea
- Diagnostic tools: bedside ultrasound
- Treatment: diuresis and BiPAP for respiratory support
- Not all wheezing is asthma
- Consider heart failure in the differential and tailor treatment accordingly
References
1. Buckner K. Cardiac asthma. Immunol Allergy Clin North Am. 2013 Feb;33(1):35-44. doi: 10.1016/j.iac.2012.10.012. Epub 2012 Dec 23. PMID: 23337063.
2. Hollingsworth HM. Wheezing and stridor. Clin Chest Med. 1987 Jun;8(2):231-40. PMID: 3304813.
Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3
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