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Wheezing That Is Not Asthma

Cough and cold season is officially upon us, and I am starting to see lots of kids who are wheezing. Now everyone knows that people with asthma can have wheezing, but not all that wheezes is asthma. There are plenty of other reasons that kids have wheezing, so be careful not to jump to premature conclusions (a.k.a., don’t freak out that your child has asthma just because your pediatrician says that your child is wheezing for the first time).

What is wheezing?

Wheezing is an abnormal breath sound. It is characterized by a high pitched whistling sort of sound. The sound is usually heard on expiration (breathing out). Wheezing is usually heard in the lungs with a stethoscope. Technically speaking, wheezing is not just noisy breathing (although they often get lumped together). There are all sorts of different causes of noisy breathing including airway and nose issues that are not wheezing.

Causes of wheezing

While asthma is probably the number one reason that kids wheeze, this article is exploring other causes of wheezing. It is also worth noting that when kids have wheezing for the first time, they are not diagnosed with asthma. While the child may eventually end up with a diagnosis of asthma, first time wheezing never gets diagnosed as asthma (because of the other possible causes). Let’s look at the other possible causes:

  1. Viral infections. Many common viruses that infect the lungs can cause inflammation. When the airways get inflamed, wheezing results. RSV (respiratory syncytial virus) is one of the most common viruses that cause wheezing.
  2. Bacterial infections. Similar to viral infections, bacterial infections can also cause inflammation of the lungs and subsequent wheezing. Bacteria, like pertussis, can cause wheezing. Sometimes pneumonia develops and the patient will also develop wheezing.
  3. Foreign body aspiration. If your child has inhaled something into his/her airway, then localized wheezing will often develop. The lungs will be irritated by the foreign object and create inflammation around the object. When that happens, the child will develop wheezing. Foreign body inhalation/aspiration happens almost exclusively in the very young child.
  4. Genetic causes. Conditions like cystic fibrosis may cause wheezing.
  5. Lung malformations. If the lungs are not formed properly (either from prematurity or otherwise), then children can have wheezing.
  6. Upper airway problems. This is a tricky cause. Technically “wheezing” heard from these causes are not truly wheezing, but commonly misdiagnosed as such. These include reasons like vocal cord dysfunction or laryngomalacia.
  7. Heart problems. There are few (much less common) heart conditions that will cause a “wheeze.” A very skilled physician will be able to help distinguish the cardiac wheeze from a lung wheeze. Cardiac wheezing warrants a referral to a pediatric cardiologist (specialist).

Treating wheezing

How to treat the child who has wheezing entirely depends upon the cause of the wheeze. You certainly wouldn’t give inhalers (designed for inflamed lungs) to a kid who had a cardiac (heart) wheeze. Many of the causes of wheezing (including asthma and infections) get treated similarly, with inhalers. There are essentially two different types of inhalers:

  1. Preventative inhalers. These deal with the problem of inflammation in the lungs. The medication class is inhaled corticosteroids.
  2. Rescue inhalers. These deal with the problem of the muscles in the airways getting tight. The medication is a form of albuterol. Inhaled meds can be given through a nebulizer machine or inhalers (used with a spacer).

When to worry

Because wheezing is a finding discovered on auscultation (listening with a stethoscope), most parents won’t realize their child is wheezing until they are already at the doctor. The doctor will then help determine the scope of concern based on severity of symptoms. If by chance your child is having enough trouble breathing to be actually audible without a stethoscope, you should seek immediate medical attention. Generally speaking, wheezing is not normal. If it is happening, you should have your child seen by his or her pediatrician.