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:
- 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.
- 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.
- 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.
- Genetic causes. Conditions like cystic fibrosis may cause wheezing.
- Lung malformations. If the lungs are not formed properly (either from prematurity or otherwise), then children can have wheezing.
- 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.
- 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).
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:
- Preventative inhalers. These deal with the problem of inflammation in the lungs. The medication class is inhaled corticosteroids.
- 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.
The Asthma and Allergy Foundation of America (AAFA) calls May the National Asthma & Allergy Awareness month because this is the peak season for problems. So it seemed fitting to write about asthma and increase awareness.
Asthma is major health concern in America. Did you know (according to the AAFA)
- 10 people a day die from asthma
- Asthma affects 24 million Americans
- 3 million children (younger than 18) have asthma
Asthma is chronic disease that causes the airways in the lungs to be inflamed. The inflammation causes the airways to become narrow. Those narrow airways spell trouble whenever the demands on the lungs are increased. Those demands, or “triggers,” make it difficult to breathe when a person has asthma.
Common Asthma triggers
- Cigarette smoke (both first and secondhand)
- Cold air/weather
- Molds and dust
If you don’t have asthma, it can be hard to understand what having an attack feels like. Imagine running a mile and only being allowed to breathe through a straw. Pretty quick you would feel terrible. Your head would hurt and you’d feel dizzy (from not getting enough oxygen to your brain). You’d be seriously winded, extremely tired, and your chest would be hurting. Even when someone with asthma is not having an attack, it is common to still be symptomatic.
Asthma Signs and Symptoms
- Cough (especially worse at night and first thing in the morning)
- Cough with exercise
- Shortness of breath
- Chest tightness
What Causes Asthma?
The short answer is we don’t exactly know. The longer answer is that science has shown a number of different contributing factors.
- There’s a lot of different science to show that early and frequent exposure to certain common allergens and infections decreases the risk of developing asthma. For example, having a pet early in life can decrease the risk of developing asthma, but later the pet can act as a trigger. Coming from a large family or living on a farm is also protective against asthma. Early use of antibiotics in life is also linked to asthma (yet another reason to judiciously use antibiotics). Viruses can both decrease and increase the risk. For example, early exposure to respiratory syncytial virus (RSV) increases the risk.
- There is a strong genetic component to developing asthma. There are many specific genes that have been linked to development of asthma. Families that are “atopic,” that is, those with eczema, allergies, and asthma, are also at increased risk. So while one condition (e.g., eczema) doesn’t lead to the other (e.g., asthma), having one, increases the risk of developing another. This phenomenon is often referred to as the “atopic march.”
There is no cure for asthma. You may have heard of kids “outgrowing asthma.” While not exactly true, the concept is that the lungs continue to grow and develop in the first 6-8 years of life. Many kids, who had trouble when they were toddlers, will get better as their lungs mature. Treatment generally consists of using medications (commonly inhalers) to modify symptoms and avoiding triggers. Inhalers are divided into 2 groups:
- Controller inhalers. These medications are used daily to prevent the asthma attack. Generally, these are inhaled steroids.
- Rescue inhalers. These medications are used on an as needed basis to deal with symptoms when the asthma has flared.
You will work with your child’s pediatrician to help determine the severity of your child’s asthma. The severity will determine what and how often you’ll be giving your child medication. (As an aside, prep yourself. The medications can be really expensive and unfortunately, there aren’t a lot of generic drugs available).
If you managed to read the entire article, here’s the comical reward for your efforts. Whenever I write an article, I often double check facts (especially if I quote a statistic). I discovered this interesting historical note about asthma. In the 1930s-1950s, asthma was considered one of the “holy seven” psychosomatic illnesses. Asthma was considered psychological and was consequently often treated with psychoanalysis and other talking cures. The “wheeze” (which is really from a constricted/tight airway) was thought to be a suppressed cry of a child for its mother. The treatment of depression was especially important for people with asthma. Isn’t that a riot? If your doctor prescribes Prozac to your child who is having an asthma attack, your doc may be a little too old school. Throw that little historical nugget out at your next dinner party.