Bronchiectasis. The cause of breath sounds is narrowing of the lumen of the airways and the accumulation of mucus, blood, foreign bodies in them. An obstruction in the path of the air flow causes the occurrence of wheezing sounds.
You can detect wheezing when breathing with the naked ear or with the help of a phonendoscope and a stethoscope. In children, wheezing is much more difficult to identify than in adults. This is due to the characteristics of the child's body: in young children, normal breathing is often observed, which is typical for SARS in adults. If a sick child does not have a fever, it is almost impossible to detect wheezing sounds. Children without fever feel good and cannot sit still while the pediatrician examines them.
sputum, narrowing and pathological changes in the elements of the airways - the causes of wheezing during breathing
Wheezing is an important symptom of pathological changes in the lungs or bronchi accompanied by such clinical signs as difficulty breathing, chest pain, weakness, fatigue, myalgia, arthralgia, fever, hyperhidrosis.
Types of wheezing
According to localization, wheezing sounds are pulmonary, bronchial, tracheal and extrapulmonary.
Wheezing from the throat and nasopharynx occurs after a long cry, with or. Pulmonary rales are signs of bronchopulmonary pathology, and extrapulmonary rales are a symptom of dysfunctions of other organs and systems: the heart, blood vessels, kidneys.
There are the following types of wheezing:
Each type of wheezing corresponds to a specific disease and is determined by the characteristics of its course.
Etiology
Localization, mechanism of formation and intensity of wheezing are determined by the cause of their occurrence. There are 2 etiological factors for the formation of pathological noises in the bronchi and lungs:
- Spasm or narrowing of the lumen of the bronchi,
- The presence in various parts of the respiratory system of a thick and viscous mucopurulent secret, which fluctuates during breathing and creates sound vibrations.
Wheezing is a nonspecific symptom of most diseases of the respiratory, cardiovascular and other body systems. It does not allow to make a diagnosis and correctly assess the patient's condition. In order to accurately diagnose the pathology and prescribe effective treatment, all symptoms must be taken into account, as well as data from additional research methods - instrumental and laboratory.
In infants, wheezing in the throat is physiological. In children up to 4 months, the process of swallowing saliva is formed, and up to one and a half years the respiratory organs develop. If the child's body temperature remains normal, sleep and appetite are not disturbed, you should not worry. A consultation with a pediatrician will rule out heart disease and allergies. Wheezing in combination with a runny nose, cough, lethargy and blue lips are a sign. Parents should immediately call an ambulance.
Dry wheezing
Dry wheezing occurs when there is an obstruction in the airways, formed from dense and thick contents. Another cause of dry wheezing in the bronchi is a spasm of smooth muscles or narrowing of their lumen due to inflammatory edema, foreign body, tumor growth.
Liquid discharge does not take part in the formation of dry rales. That is why such breath sounds got such a name. They are considered unstable, changeable and occur with inflammation of the pharynx, larynx, bronchial asthma.
A jet of air, passing through the affected airways, creates turbulent eddies, which manifests itself in the formation of wheezing sounds.
The main characteristics of dry rales depend on the degree of damage and the caliber of the inflamed bronchus:
- By the number of wheezing are single and multiple, scattered throughout the bronchi. Bilateral dry wheezing is a symptom of generalized inflammation in the bronchi and lungs. Unilateral wheezing sounds are detected over a certain area and are a sign of a cavity.
- The tone of wheezing is determined by the degree of resistance of the bronchi to the air stream passing through them. They are low - buzzing, bass, high - whistling, hissing.
- In bronchial asthma, dry wheezing resembles a whistle and is a sign of bronchospasm. Filamentous mucous membranes in the bronchi are manifested by buzzing wheezing, which can be heard at a distance.
Dry wheezing without coughing and other symptoms occur not only in pathology, but also in the norm. They form in response to dry air. Dry wheezing sounds can be heard when communicating with older people. After a deep breath or a slight cough, they completely disappear.
Whistling dry wheezing is a sign of dysphonia, paralysis of the vocal cords and hematoma of the surrounding soft tissues. Diseases of the oral cavity, pharynx, larynx and esophagus are accompanied by dry wheezing:, retropharyngeal abscess.
Wet rales
The appearance of wet rales is due to the accumulation of liquid contents in the bronchi, lungs and pathological cavities - caverns, bronchiectasis. A stream of inhaled air passes through liquid sputum, bubbles form, which burst and generate noise.
Depending on the caliber of the affected bronchi, moist rales are divided into small, medium and large bubbling. The first are formed in the bronchioles, alveoli and the smallest bronchi, the second - in the bronchi of medium caliber and small cavities, the third - in the large bronchi, cavities and trachea.
Wet rales are consolidating and non-consolidating. The first appear with pneumonia, and the second - with stagnation in the lungs due to chronic heart failure.
Moist rales sometimes become dry, and dry rales very often become moist. As the disease progresses, their main characteristics may change. These signs not only indicate the nature of the course and the stage of the disease, but can also signal the progression of the pathology and the deterioration of the patient's condition.
Diagnostics
The main diagnostic method for detecting wheezing is auscultation. This is a special medical manipulation carried out using a phonendoscope or stethoscope. During auscultation, all segments of the chest are listened in turn in different positions of the patient.
Auscultation allows you to determine the origin, nature and localization of wheezing. To make a diagnosis, it is important to find out the caliber, tonality, timbre, sonority, prevalence, uniformity, and the number of wheezing.
Auscultation may reveal crepitus, resembling crackling or crackling when breathing.. This is a sign of the accumulation of inflammatory fluid in the alveoli of the lungs. They stick together, and at the height of inhalation, the air causes them to come apart, and a sound effect is formed, comparable to the sound of hair rubbing between fingers. Crepitus is a pathognomonic symptom of pneumonia and fibrosing alveolitis.
Diagnosis of diseases manifested by wheezing in infants is difficult. Babies can't tell what hurts them. In infants, wheezing can be a consequence of crying or a symptom of a serious illness. In order not to miss it, it is necessary to observe the baby during and after crying. If the child quickly calms down in his arms and behaves normally, despite wheezing, then you can not worry. And if he suffocates and turns blue, it is urgent to call an ambulance. Such signs indicate a serious infectious disease or foreign objects entering the respiratory system.
For the correct diagnosis of patients with wheezing, the doctor suggests undergoing a series of laboratory and instrumental studies: a complete blood count, microbiological sputum analysis, radiography of the mediastinal organs, spirography, tomography, lung biopsy.
Treatment
To get rid of wheezing in the chest, it is necessary to cure the underlying disease which became their direct cause. The treatment of wheezing in the broncho-pulmonary system is carried out by doctors of the following specialties: pulmonologist, therapist, cardiologist.
Traditional treatment
Etiotropic treatment consists in the use of antibiotics or antiviral drugs.. If the pathology was provoked by a bacterial infection, patients are prescribed broad-spectrum antibiotics from the group of fluoroquinolones, macrolides, penicillins, cephalosporins. In case of viral damage to the respiratory organs, antiviral therapy with drugs is indicated. "Kagocel", "Ingavirin". Interferon preparations are dripped into the nose for children, rectal suppositories are injected into the rectum "Viferon" or give sweet syrup "Tsitovir". If the cause of wheezing is an allergy, then the use of antihistamines of general and local action is indicated - " Suprastin", "Tavegil", "Loratodin", "Flixonase", "Kromoglin".
Pathogenetic therapy of diseases of the respiratory system, manifested by wheezing, consists in the use of drugs of the following pharmacological groups:
- Mucolytics that thin sputum and facilitate its excretion - Fluimucil, ACC,
- Expectorants - "Ambroxol", "Bromhexine", "Mukaltin".
- Bronchodilators that relieve bronchospasm - "Berodual", "Atrovent", "Salbutamol",
- Phytopreparations - breast collection, chamomile tea.
ethnoscience
Wheezing without fever responds well to folk remedies.
The following traditional medicine will help get rid of wheezing in the lungs in children and adults:
- Decoctions of medicinal herbs - coltsfoot, licorice, thyme, chamomile.
- Infusions of plantain, raspberry, eucalyptus, elderberry, viburnum, cranberry.
- Inhalations over potato peels, soda inhalations or inhalations with essential oils.
- Honey mixed with butter and egg yolks.
- Radish juice mixed with honey.
- At normal body temperature - compresses on the chest from potato or mustard-honey cakes. A highly effective remedy for wheezing is an oil compress.
- Milk with honey is a popular remedy for coughs and wheezing. Patients are advised to eat honey with a spoon and drink it with hot milk.
- Onion syrup is prepared as follows: the onion is chopped, covered with sugar and insisted. Take the syrup several times a day until the wheezing in the lungs disappears.
- Milk with sage is taken at bedtime.
- Heated alkaline mineral water with honey helps to get rid of moist rales.
Prevention
Prevention of wheezing in children and adults consists in the timely detection and treatment of the underlying disease, as well as in maintaining health. It includes the following activities:
Video: wheezing and lung auscultation
Wheezes in the lungs are pathological noises that occur during breathing. This symptom most often indicates inflammatory diseases of the bronchopulmonary system, but can also be a symptom of pathologies that are not associated with the lungs or bronchi.
Establishing the primary cause of the appearance of extraneous noise during breathing is an important stage in the treatment, since it is not always possible to eliminate the disease with anti-inflammatory or other drugs.
Causes of wheezing in the lungs
In most cases, wheezing in the lungs occurs with pneumonia, bronchopneumonia and acute or chronic bronchitis. At the same time, the general well-being of a person also suffers. We are used to the fact that pneumonia must be accompanied by a rise in temperature, but there are atypical forms of pneumonia in which the clinical picture differs from the standard course of the disease. Therefore, wheezing in the lungs in some people may be without a rise in temperature. In addition to pneumonia, pathological noises in the organ are also heard in other diseases of extrapulmonary origin. These are myocardial infarction, cardiac pathologies, pulmonary edema as a result of a severe course of somatic diseases.
Wheezing in different parts of the lung is heard with:
- Tuberculosis.
- Abscess.
- Pneumofibrosis.
- Malignant neoplasms.
Under these conditions, the temperature may not be there, or it occurs periodically and rises to 37 or slightly above degrees. At the heart of the formation of pathological noises are two processes:
- A change in the normal state of the walls of the bronchi, which leads to a narrowing of their lumen.
- The presence in the vessels of the respiratory system of mucous or purulent masses with varying degrees of their viscosity. This secret, under the influence of air, begins to fluctuate, and different sounds arise in all parts of the lungs and in the bronchi.
When listening to the respiratory system, the doctor pays attention to the different characteristics of sounds, that is, to their sound. When they are formed - on inhalation or exhalation. Diagnostic value is also how moist rales in the lungs manifest themselves. They can be large bubbles, medium and small.
In some pathologies of the bronchopulmonary system, wheezing is heard only on exhalation, while in others, on inspiration, there may also be mixed wheezing sounds. With bronchial asthma, the sounds on the exhalation are more clearly audible, they are called expiratory sounds. Inspiratory wheezes are designated by the term inspiratory, they can be heard clearly in acute bronchitis.
In the lower parts of the lungs, the appearance of wheezing occurs due to congestion. The walls of the alveoli become inflamed, swell and secrete exudate that disrupts the process of normal breathing. If the treatment is carried out according to the correct scheme, then the inflammatory process is eliminated and gradually the mucopurulent secret comes out and breathing normalizes.
Prolonged wheezing in the lower parts of the organ can be detected in adults with chronic obstructive pulmonary disease. This disease is often recorded in those who smoke, who have not been fully treated for chronic bronchitis. Moreover, changes in breathing appear even without temperature.
What to do with wheezing in the lungs
Hearing any wheezing in the lungs, the first thing to do is to be examined. The doctor begins to find out the causes of the disease by listening to the bronchopulmonary system. Based on the data obtained, treatment is prescribed immediately or after additional diagnostics. The most commonly used radiography of the bronchi and lungs, this method with high accuracy allows you to establish bronchitis or pneumonia. Additionally, blood tests are prescribed, sputum is taken to determine specific pathogens.
With an unclear diagnosis and suspicion of a neoplasm in the organ cavity, CT is currently used, that is, layered computed tomography of the lungs.
It is absolutely impossible to treat wheezing in the lungs on your own. Taking various medications can drown out the inflammatory process, but it is unlikely that it will be possible to cope with all the changes and complications. And this almost always leads to the transition of an acute disease to a chronic one, which will require long-term therapy.
Treatment of inflammatory pathologies in the lungs
Since wheezing in the lungs most often occurs with inflammation of the organ, treatment begins with the appointment of antibiotics. In pneumonia, in most cases, Kanamycin, Ceftriaxone are used. Medicines are preferred to be administered in the form of injections, this form of medicine is absorbed by the body more efficiently.
ACC is one of the effective drugs in such cases.
Antibacterial treatment is also prescribed if the inflammation occurs without fever. In addition to this group of drugs, drugs are used that help thin viscous and dense purulent sputum. These are Cysteine, Mukobene, Mukomist. After the sputum becomes less viscous, drugs are prescribed to enhance expectoration - ACC, Mukaltin, Lazolvan. Treatment of pneumonia proceeds more successfully if drug therapy is combined with physiotherapy and massage. These additional therapies improve blood circulation and increase sputum discharge.
Folk remedies can also bring benefits in the treatment of inflammatory diseases of the bronchopulmonary system. If there is no temperature, then you can put warm compresses on the chest and back area. Under their influence, blood circulation in the bronchi increases, and they quickly get rid of softened mucus. Steam inhalations also help to reduce the viscosity of the purulent secretion. Children and adults can drink decoctions of anti-inflammatory and expectorant herbs. Immunity is increased by vitamins, good nutrition, bee products.
During the recovery period, drafts and hypothermia should be avoided. It is better not to take the child to a children's institution for at least a week after the course of aspen treatment, especially for the cold season. Hardening and playing sports increase the functioning of the immune system, which leads to a decrease in the number of colds and respiratory diseases.
The development of pathological processes in the organs of the upper and lower respiratory tract is accompanied by the manifestation of such a symptom as wheezing in the lungs. They occur due to the accumulation of mucus in the trachea, bronchi or lungs, as well as airway stenosis..
Wheezes are called noises that occur in the respiratory system due to the passage of air through them under the condition of any obstacle. This may be mucus, swelling of the bronchi, or the presence of a foreign object.
The sounds that appear in this case are varied. They resemble gurgling, buzzing and even whistling.
Why wheezing occurs
In most cases, the nature of the origin of wheezing lies in inflammatory diseases localized in the lower respiratory organs. This:
- pneumonia;
- pneumofibrosis;
- acute or chronic form of bronchitis;
- pulmonary tuberculosis;
- lung abscess;
- asthma.
Listening to noises not associated with diseases of the respiratory organs is observed in pathologies such as:
- diseases of the heart and blood vessels;
- myocardial infarction;
- pulmonary edema against the background of somatic pathologies;
- oncology.
Regardless of the disease that caused the appearance of wheezing, they are heard in the lungs due to two main factors that activate the mechanism for the occurrence of noise:
- Stenosis (narrowing) of the lumen in the bronchi.
- Formation of sputum or pus in the respiratory organs. Excessive production of mucus, which prevents the free passage of air, is set in motion during breathing, as a result of which all kinds of sounds appear in various areas of the lungs and bronchi.
In addition, almost any cough with influenza, colds, SARS is accompanied by difficulty breathing and the occurrence of a variety of wheezing.
Other reasons
Among the negative factors that provoke wheezing in the lungs during breathing, the following conditions and situations are noted:
- Allergic reaction. The development of laryngeal edema against the background of allergies, the appearance of an intense cough and runny nose are accompanied by noisy breathing of a different nature. Dust, pollen of flowering plants, medicines, household chemicals, pet hair, and various products act as irritants.
- The possibility of wheezing in the lung area due to foreign objects entering the respiratory tract is not excluded. These are small pieces of food, children's toys, swallowed by negligence during a game or conversation in the process of eating food. Foreign bodies, blocking the free passage of the air stream into the lungs, provoke the occurrence of mechanical noise.
- In infants, wheezing in the throat up to four months of age is considered normal. This is due to the imperfection of the respiratory apparatus, which is formed up to 1.5 - 2 years. This condition can be taken calmly if there are no symptoms such as high fever, refusal to eat, restless sleep. Anxiety, concern and immediate medical attention are caused by manifestations of wheezing with concomitant cough and runny nose, accompanied by cyanosis of the nasolabial triangle and with a temperature of about 40 °. This may indicate a serious disease - croup, which threatens the life of the baby.
Intense coughing and wheezing in the lungs without fever are often observed in heavy smokers, as well as in people whose professional activities involve prolonged exposure to dusty or gassed rooms.
Classification of species and types
There are two main categories of pathological manifestations - wet and dry wheezing.
Wet
Their appearance is associated with the formation of mucus, blood flakes and excess fluid caused by edema. All this negatively affects the state of the respiratory system and greatly complicates the respiratory process.
The following happens:
- a jet of air overcomes the obstacle created by sputum that has settled on the walls of the bronchi;
- as a result, small air bubbles are formed and then burst;
- due to their formation in large quantities, moist rales are observed.
Depending on the quantitative composition of mucus accumulations, the following types of moist rales are distinguished:
- Fine bubbles.
- Medium.
- Large bubble.
The formation of small bubbles is accompanied by a noise similar to the sounds produced by a foaming liquid.
Medium bubbling rales are heard in the form of gurgling sounds that occur when air passes through the tube, if it is immersed in a vessel with water and blown. Such noises sometimes resemble crackling - crackling wheezing is heard. Such manifestations are characteristic of the onset of the disease, accompanied by the development of edema in the lungs.
The accumulation of sputum, localized in the upper respiratory tract - bronchi or trachea, causes the formation of large bubbles. Their presence in the respiratory organs provokes bubbling breathing. Such wheezing indicates a neglected disease of the bronchi or lungs, as well as a weak manifestation of the cough reflex, during which excess mucus is excreted.
Dry wheezing
The occurrence of a spasm, accompanied by stenosis of the airways, or the consequences of an injury, is the cause of noises resembling a vortex-like movement of air. This type of wheezing is observed most often. They signal the beginning of the pathological process in the respiratory system. Sound effects of the following sound scale are observed:
- whistling. The place of localization are the narrow sections of the bronchi. These noises come in high and low pitch. Conditions in which such wheezing is detected are bronchial asthma, chronic diseases of the respiratory system, the formation of neoplasms of various etiologies, as well as the presence of a foreign object in the trachea or bronchi.
- Buzzing. For bronchi, characterized by a large volume, dry rales of this type are characteristic. They arise due to the sticking of thick mucus on the mucous membrane of the bronchial tube.
- Noises sometimes resemble crackling - crackling wheezing is heard. Such manifestations are characteristic of the onset of the disease, accompanied by the development of edema in the pulmonary system.
It is not always possible for the patient to hear wheezing in the lungs. This is how remote noises are heard, which are heard not only by the patient, but also by others. Noises of another type can be detected with a thorough examination. Almost all types of wheezing represent a health hazard.
Noises that appear at different stages of the respiratory process
Their occurrence in some cases is heard with a deep breath, sometimes wheezing is heard during exhalation.
Wheezing when inhaling (inspiratory) is a characteristic symptom of acute bronchitis. Expiratory wheezing manifestations, heard on the exhalation of air, are a sign of bronchial asthma.
Mixed-type noises are heard due to inflammation of the walls of the alveoli, which are puffy. Such changes lead to intensive formation of exudate, which causes difficulty in breathing and pathological noises that can manifest themselves both on inhalation and exhalation.
Determining the type of negative noise is an important diagnostic indicator that helps to differentiate various diseases.
Clinical picture
The most expressive symptom is the inconstancy of the localization and nature of wheezing. Noise in the lungs manifests itself as follows:
- it is permanent and short-lived;
- in intensity - weakening and increasing;
- by localization - due to the movement of mucus, it is felt in one part of the bronchi, then in another, it disappears and appears depending on the intensity of the cough;
According to the expressiveness of noise effects, wheezing is also inconsistent - from whistling to crackling.
Other manifestations
In addition to the inconsistency of wheezing, there are other accompanying symptoms. Among them:
- severe swelling, spasms;
- dyspnea;
- cough;
- suffocation;
- pain in the trachea and bronchi;
- burning, perspiration, tickling;
- hard breathing;
- chilliness;
- in an adult patient, wheezing may occur without temperature, in children - more often with its high rates.
The long course of the disease, accompanied by pathological wheezing, causes a deterioration in the general condition of the patient, weakness and excessive sweating.
Diagnostic Measures
The appearance of wheezing or the described accompanying symptoms becomes a signal to consult a doctor, undergo a thorough examination, the purpose of which is to identify the underlying disease that caused their manifestation.
After listening to the patient's complaints and listening to the area of the bronchi and lungs with a phonendoscope, the doctor prescribes the following diagnostic procedures:
- clinical blood test;
- microbiological examination of sputum;
- x-ray;
- spirography;
- biopsy.
In the complex of diagnostic measures, these types are not always used. Sometimes, to establish a diagnosis, it is enough to conduct an x-ray, with the help of which pneumonia and bronchitis are detected.
Treatment
Trying to cure wheezing without clarifying the diagnosis and prescribing professional specialists (therapist, pulmonologist, cardiologist) is not recommended.
Independent uncontrolled use of medications for some time will muffle the pathological process, mask the negative symptoms, but will not eliminate the root cause of the disease.
The selective approach to the choice of drugs is due to the nature of the inflammatory process:
- Antibiotics. The purpose of this group of drugs is used for diseases caused by bacterial pathogens. The detection of pneumonia involves a course of treatment with Ceftriaxone, Kanamycin or representatives of the penicillin series. Positive dynamics is observed quite quickly with the injection of drugs.
- Mucolytics that thin mucus. Mukomist, Fluimucil, Mukobene are recognized as the most effective representatives of this group.
- Expectorants. The removal of sputum from the respiratory tract is facilitated by the use of Mukaltin, Bromhexine or ACC.
- The defeat of the respiratory tract infection of viral origin involves the use of antiviral agents. Ingavirin and Kagocel are considered the most effective. Children in this situation are prescribed Interferon, Cytovir (syrup) and rectal administration of Viferon (candles).
- Antihistamines. Wheezes of allergic etiology are eliminated by the use of Suprastin, Cromoglin, Tavegil.
- Bronchodilators. Their use is due to the need to relieve spasm in the bronchi. Salbutamol, Atrovent and Berodual act quickly and effectively.
For the treatment of cough - a frequent culprit of wheezing - it is recommended to take herbal remedies. Camomile tea and Breast collection have proven themselves well.
Comprehensive treatment involves the use of massage and exercise therapy. Thanks to these techniques, blood circulation improves, enriching the respiratory organs with oxygen, which greatly contributes to the removal of mucus from them.
How to treat at home
It is not possible to eliminate wheezing by resorting exclusively to traditional medicine. This is an additional component of the overall therapeutic treatment.
Sufficiently effective means, which are very popular in the treatment of wheezing in the lungs, are recognized:
- An infusion of plantain leaves, viburnum, raspberry leaves or berries.
- A decoction of chamomile or thyme.
- Inhalations using potato decoction, soda with salt or Asterisk balm.
- Children for inhalation are recommended to use nebulizers with special pharmacy solutions or a saline solution prepared on their own. In 200 ml of warm boiled water, add 1 tsp. salt.
- A proven remedy for wheezing is milk (200 ml) with honey (1 tsp), soda (at the tip of a knife) and butter (3 g). Drink preferably before bed.
The use of folk recipes alleviates the condition, but does not eliminate the cause of the disease. Therefore, one should not rely solely on their use.
Forecasts
The effectiveness of treatment directly depends on a timely visit to a doctor, a thorough examination to identify the underlying cause of wheezing, and strict adherence to the instructions of the attending physician.
Self-treatment is fraught with the likelihood of a protracted course of the disease, the development of chronic forms of pathology, which leads to the need for a long therapeutic effect.
According to the mechanism of wheezing, as well as the sound sensation obtained when listening to them, wheezing is divided into dry and wet.
Wet rales occur if fluid accumulates in the bronchi (liquid secretion or blood); a passing stream of air foams the accumulated liquid, the bubbles formed on its surface burst and are perceived by the ear of the examiner as moist rales. With the accumulation of fluid in the bronchioles and small bronchi (bronchopneumonia, bronchiolitis), fine bubbling rales are heard; if liquid secretion or blood is contained in the bronchi of medium or large caliber (bronchitis, pulmonary edema) or in the corresponding sized cavities (bronchiectasis, abscess,), medium or large bubbling rales are heard. It is necessary to differentiate small bubbling rales from crepitus (see). With compaction of the lung tissue around the cavity, moist rales become sonorous.
Dry wheezing occur in violation of bronchial patency (bronchus, its deformation or compression, swelling of the bronchial mucosa or accumulation of viscous sputum in them). Their formation is associated with vortex-like movements of air in places of constriction.
Buzzing (bass) dry rales are formed in the large bronchi, whistling - in the bronchi of small caliber, bronchioles.
With extensive violations of bronchial patency, dry whistling rales are heard over all lung fields (for example, bronchial asthma, bronchitis).
The persistence of dry rales over any area of the lung tissue is a symptom of a local inflammatory focus or tumor, causing a decrease in the lumen of the bronchi.
Wheezes (rhonclii) are pathological respiratory noises that occur in the bronchi, trachea, and also in pathological lung cavities (abscess, cavity, bronchiectasis). In the absence of cavities in the lungs, the appearance of wheezing indicates a violation of bronchial patency. There are dry and wet rales.
Dry wheezing
have a single mechanism of formation - narrowing of the lumen of the bronchus that occurs with spasms of the bronchus (bronchial asthma), swelling of the bronchial mucosa (inflammation, allergic reactions), in the presence of a mucous viscous secret that sticks to the walls of the bronchi
(bronchitis), with the growth of a bronchogenic tumor or compression of the bronchus from the outside (tumor, enlarged lymph node, inflammation). In areas of narrowing of the bronchi, the passing air makes additional vortex-like movements, which cause the appearance of dry wheezing. Dry rales are heard during inhalation and exhalation. Depending on the width of the lumen and the degree of narrowing of the bronchus, high (treble) - whistling and low, buzzing - bass rales are distinguished. Higher dry rales (rhonchi sibilantes) occur in small bronchi, and lower ones (rlionchi sonores) - in large ones. Dry wheezing is characterized by great volatility: in a short period of time and in the same area, their number may either increase or decrease, they may disappear and reappear. When coughing, a viscous secret moves from one bronchus to another, so wheezing can change its character - disappear in the place where they were heard before coughing, and appear where they were not before coughing. This makes it possible to distinguish them from other additional respiratory sounds (crepitus, pleural friction noise), which do not change when coughing. The more energetic the movement of the masses in the bronchi, the louder the wheezing. Since with deep breathing the speed of air movement in the bronchi increases, the amplitude of the oscillations increases and the volume of wheezing increases. Therefore, when listening, the patient should be forced to breathe deeper. During exhalation, the air flow velocity in the bronchi is less than during inhalation, therefore, during exhalation, wheezing is heard less clearly than during inhalation. The exception is bronchial asthma, when dry rales are heard mainly during exhalation.
Permanent dry rales over any part of the lung tissue are of great diagnostic value, as they are a symptom of a local inflammatory focus or tumor in the lung, which reduce the lumen of the bronchus.
Wet rales occur in the bronchi and pathological cavities of the lungs if the secret contained in them has a liquid consistency (liquid sputum, exudate or transudate, blood). They resemble the sound of air bubbles bursting in water blown through a tube. In most cases, the mechanism of occurrence of wet rales is just that. Air, passing during inhalation and exhalation through the fluid that fills the bronchus, foams it. Bubbles, rising to the surface of the liquid, burst and are perceived when listening as moist rales. According to B.S. Shklyar, the described mechanism for the occurrence of moist rales can only be if the contents of the bronchi are completely liquid. If the masses contained in the bronchi are semi-liquid (thick sputum), then it is difficult to admit the possibility of air passing through them with the formation of bubbles. In these cases, apparently, a semi-liquid film is formed in front of the air jet, which, stretching, gradually becomes thinner and bursts, making a sound perceived as a wet wheezing.
The size of the resulting air bubbles depends on the strength of the air jet, its speed, the amount of secretion, and mainly on the width of the lumen of the bronchi or the diameter of the pathological cavities. When listening, some of the moist rales resemble the sound of bursting smaller bubbles, others - larger ones. Therefore, moist rales are divided into coarse, medium and fine bubbling. Large bubbling rales occur in large bronchi with pulmonary edema and in pathological cavities. Tracheal bubbling rales usually appear in a serious condition of the patient, when he is not able to expectorate mucus from the trachea. Such wheezing is often heard during the period of agony. The appearance of coarse rales over the peripheral parts of the lungs, where there are no large bronchi, may indicate the formation of a cavity.
Medium bubbling moist rales are formed in the bronchi of medium caliber and are a sign of bronchitis or appear with congestion in the pulmonary circulation.
Small bubbling wet rales occur in the small and smallest bronchi with inflammation of the mucous membrane of the latter (bronchitis, bronchiolitis). Small bronchi are often involved in the inflammatory process when the lung is damaged, so moist fine bubbling rales are often determined in focal pneumonia. The presence of wet fine and medium bubbling rales in the lower sections of both lungs is often associated with circulatory failure, in which blood stasis develops in the pulmonary circulation (heart defects, cardiosclerosis, cardiac asthma).
Moist rales are divided into sonorous and non-voiced. The sonority of wheezing depends on the degree of conduction of sounds by the lungs and on the presence of resonance. With an increase in the sound conductivity of the lungs (seal) and especially in the presence of resonance (cavity), moist rales become sonorous. With caverns, sonorous moist rales often have a metallic tint. This is facilitated by the compacted lung tissue surrounding the cavity, which enhances the resonance.
Inaudible moist rales are heard in bronchitis, congestion in the lung. It is necessary to differentiate small bubbling rales from crepitus (see) and pleural friction noise. Fine bubbling moist rales are heard at different times in both phases of breathing, while crepitus is heard only at the height of inspiration in the form of an "explosion". Moist rales change after coughing (increase, decrease, change their localization), but crepitus does not change. To distinguish the pleural friction noise from moist rales, the patient is asked to cough - while the rales change, but the pleural friction noise does not change; they ask the patient to close his mouth and pinch his nose, and then draw in and protrude his stomach - the pleural friction noise is heard, but there are no wheezing, since there is no air intake. When breathing, the pleural friction noise is most often
accompanied by pain in the corresponding half of the chest, which does not happen with wheezing.
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Many people during their lives are faced with such a phenomenon as wheezing. Wheezing can occur sporadically, that is, for a short period of time, and also exist for a long time, accompanying various pathological processes in the human body. The main method for detecting wheezing is to listen to the chest organs with the help of a medical instrument - a phonendoscope. Some variants of wheezing sounds can be heard with the naked ear.Definition of wheezing
To date, the concept of wheezing combines any form non-physiological noises , that is, additional sounds that occur during breathing, friction of the pleura against the ribs, etc. The wheezing sound of breathing is caused by obstructions in the path of air flow through the respiratory tract. Such an obstacle may be in the nature of a narrowing of the lumen or the appearance of pathological components in it (mucus, foreign body, etc.). Wheezing is a very heterogeneous group of breath sounds that differ in tone, duration, prevalence during inhalation or exhalation, number of tones, etc. Moreover, each specific variant of wheezing corresponds to a certain pathology, the features of the course of which form the uniqueness of the emerging respiratory noises.Characteristics of wheezing
So, rales can be wet, dry, whistling, crepitating, etc. Dry rales develop in the presence of a narrowing obstacle to the passage of the air stream, and wet - in the presence of fluid in the airways. The tone of wheezing depends on the diameter of the affected airways and the viscosity of the fluid that is in them. So, the smaller the diameter of the affected bronchus, the higher the wheezing will be heard, and the larger the diameter, the lower and “bassier” the hoarse noise becomes.Also, wheezing can occur on inhalation or exhalation. A wheeze heard on inspiration is called inspiratory, on exhalation - respectively expiratory.
Since wheezing passes through various tissues from the place of its formation in the lungs, the sonority of this auscultated sound depends on the individual characteristics of the surrounding tissues. If the tissue is dense (for example, in the presence of inflammation in the lungs or around the bronchi), then the wheezing sound becomes sonorous, but if the tissue is airy, loose (for example, in the normal state of the lungs), then the formed wheezing is heard as less sonorous, somewhat muffled.
Moist rales fall into three categories:
- fine bubbles;
- medium bubble;
- large-bubbly;
Pulmonary and extrapulmonary rales
Depending on the origin, all wheezing is divided into two broad categories:- pulmonary;
- extrapulmonary.
Pathologies accompanied by the presence of wheezing
The list of diseases that are accompanied by the development of wheezing is very wide and includes pathologies of various organs and systems. Consider the main pathological processes accompanied by various types of wheezing:
- bronchial asthma ;
- heart failure;
- sarcoidosis;
- hypertonic disease ;
- pulmonary edema;
- malignant tumors of various localization;
- bronchiectasis;
- pneumonia ;
- acute renal failure;
- heart defects (congenital and acquired);
- chronic obstructive pulmonary disease (chronic bronchitis, chronic obstructive pulmonary disease);
- acute GVHD (graft-versus-host disease);
- legionnaires' disease;
- acute respiratory viral infections;
- flu, parainfluenza;
- endemic flea typhus;
- pulmonary tuberculosis;
- pulmonary embolism (PE).
The concept of auscultation - a method of listening to wheezing
Listening to wheezing, determining their nature and exact signs is performed using a special medical manipulation called auscultation. Auscultation is performed using a phonendoscope, stethoscope or stethophonendoscope. Auscultation is performed in various positions of the patient - standing, sitting or lying down, while carefully listening to all segments of the chest on the right and left in turn. During auscultation, various breathing modes are used to determine the exact localization of wheezing and their origin, as well as listening to noises before and after coughing, against the background of pronouncing certain sounds or after taking medications.For further diagnosis, take into account:
1. wheezing caliber (small bubbling, large bubbling);
2. wheezing tone (high, low);
3. timbre of wheezing (polyphonic, monophonic);
4. sonority (voiced, muffled);
5. prevalence (over which parts of the chest are localized);
6. homogeneity (homogeneous or heterogeneous);
7. the number of wheezing (single, multiple);
8. influence on the characteristics of wheezing changes in body position, coughing or depth of respiratory movements;
9. expiratory or inspiratory character.
Wet rales - causes of development, general characteristics
Let us consider in more detail first of all moist rales. Wheezing acquires a similar wet characteristic under the influence of the accumulation of various fluids in the airways - inflammatory exudate, non-inflammatory transudate effusion, blood, mucus or sputum. Most often, such wheezing is inspiratory, but it can also be expiratory-inspiratory.Small bubbling moist rales accompany the pathological process in the alveoli of the lung, small bronchioles and bronchi. If a person is in a lying position, then finely bubbling moist rales may not be heard, so auscultation should be performed in a standing or sitting position to identify them.
Medium bubbling wet rales develop with the localization of pathological contents in the bronchi of medium caliber, and often have a crackling sound, similar to the sound of torn tissue.
Large bubbling rales characterize the pathological process localized in the large bronchi. At the same time, the sound is gurgling, bubbling, pronounced expiratory, very often heard even at some distance from the patient.
Diseases that occur with the presence of wet rales
Diseases that may be accompanied by the development of wet rales:- Williams-Campbell syndrome;
- primary ciliary dyskinesia;
- bronchial asthma (after an attack);
- bronchitis (recurrent or chronic obstructive);
- chronic obstructive pulmonary disease;
- tuberculosis;
- pulmonary edema;
- pulmonary embolism (TELA);
- bronchiectasis;
- pneumonia (at the stage of development of the disease);
- lung atelectasis.
The combination of moist rales with other syndromes and symptoms
As is clear from the above list, wet rales accompany various diseases of the respiratory system. Associated symptoms may be different, and depend on the cause of the pathology.It is appropriate to single out several accompanying wheezing syndromes:
- hypoxic syndrome;
- violation of the function of external respiration;
- asthenic syndrome;
- cough;
- hematological syndrome;
- radiological syndrome.
Asthenic syndrome includes weakness, lack of concentration, apathy, drowsiness, lethargy, bad mood.
The function of external respiration It is estimated by a number of parameters: the volume of inhaled air, the volume of exhaled air, the vital capacity of the lungs, the volume of forced inhalation, the volume of forced expiration, and others.
Hematological syndrome includes various blood disorders, for example, an increase in ESR, the number of erythrocytes, hemoglobin and leukocytes, a decrease in the saturation of an erythrocyte with oxygen, and others.
X-ray syndrome characterized by the development of a certain picture visible on the x-ray.
Wheezing, accompanying symptoms and changes in the x-ray picture in various pathologies
Consider the combination of wheezing symptom with other signs and pathological changes that occur in diseases of the respiratory system.| Respiratory disease systems | Associated symptoms | Changes in radiological picture |
| Williams-Campbell Syndrome | Chest distension, shortness of breath, wheezing breathing, coughing up sputum, finger thickening by type "drum sticks" | A large number of bronchiectasis |
| primary ciliary dyskinesia | Chronic inflammation of the bronchi and lungs, purulent sputum, thickening fingers like "drum sticks" | Foci of compaction in the lungs, bronchiectasis |
| cystic fibrosis | Dry, hacking cough from the first days of life, respiratory failure, chronic inflammation of the bronchi and lungs, delay development, thickening of the fingers by type "drum sticks" | Atelectasis, bronchiectasis, lung sclerosis |
| Bronchial asthma | Allergies, coughing fits and choking at night and in the morning, breathing with a whistling sound, respiratory failure | Emphysematous chest cell (barrel-shaped forms) |
| Chronic bronchitis | process, shortness of breath, difficult cough, sputum production, wheezing | Reinforced vascular drawing, plethora of blood vessels |
| Pneumonia | The presence of an infectious process, shortness of breath, cyanosis (blue lips, pale skin), difficulty breathing, unproductive cough at the onset of the disease, after addition of sputum | characteristic picture pneumonia |
| Pulmonary edema | Choking attack, gray or pale color skin, fright on the face, bubbling wheezing, incessant bout of suffocation cough, light, frothy sputum in large quantity, sharp increase or decrease heart rate | Large shaded spots decrease in normal lung transparency |
| Tuberculosis | Persistent cough, hemoptysis, sputum, prolonged fever, sweating, especially at night, fatigue, weight loss, thickening of the fingers of the "drum type" sticks" | Bands, meshwork of the lung pattern, focal shadows, cavities (caverns) |
It should always be borne in mind that if the disease of the respiratory system has an infectious and inflammatory nature, then all the signs and symptoms of the underlying disease will be present. Infections are caused by various pathogenic microorganisms - viruses, bacteria, fungi, which form the picture of the inflammatory process.
It is important to know that wheezing can change its character - that is, wet ones can become dry, or vice versa. Also, wheezing over the course of the pathological process can change any of its characteristics. Any changes in the nature of wheezing should be recorded and taken into account, since they indicate the features of the course or stage of the pathological process, and can serve as a signal of a worsening situation or, on the contrary, an improvement.
Causes of formation and general characteristics of dry rales
Dry rales are formed during turbulent eddies of the air stream while passing through pathologically altered airways. As a result, respiratory noises of various lengths and timbres are formed. The formation of dry wheezing is always due to the narrowing of the lumen of the bronchus, which is possible due to edema (acute or chronic), the ingress of a foreign body, a fragment of adhering sputum, compression of the bronchus by a tumor formation from the outside, growths of the mucosa and outgrowths into the lumen of a tumor nature. That is why dry rales are predominantly expiratory. Depending on the caliber of the bronchus, in which there is a pathological process, dry rales are divided into buzzing, buzzing And whistling. At the same time, the whistling timbre of wheezing develops with damage to the small bronchi and bronchioles, and buzzing and buzzing - with a disease of medium and large bronchi. Thus, the type of timbre of dry wheezing will make it possible to determine with a high degree of probability in which parts of the bronchial tree the pathological process is localized. Also, the above tones have different shades (overtones), to distinguish which one should alternate auscultation with a stethoscope and a phonendoscope. Sometimes dry rales can be heard at some distance from the patient.
Differences between dry rales and heart murmurs
To distinguish some variants of dry rales from heart murmurs, it is necessary to conduct auscultation with a change in breathing patterns, and also take into account that heart murmurs are associated with the contraction phase of the heart muscle.Pathologies in which dry rales are detected
The list of pathologies in which dry wheezing is possible is quite extensive, and includes diseases not only of the respiratory system.So, dry wheezing is accompanied by the following diseases:
- Chronical bronchitis;
- chronic bronchiolitis;
- bronchial asthma;
- pneumonia;
- bronchial tumors;
- emphysema;
- heart failure;
- foreign body in the lumen of the bronchus.
Physiological dry rales
Also, dry wheezing can form as a compensatory reaction to too dry air. Many elderly people with shallow breathing also have sporadic dry rales that disappear completely after a few vigorous breaths or forced coughing. In this situation, dry rales are not pathological, but are of a compensatory-adaptive nature.Characteristics of dry rales in various pathologies
Bronchitis, bronchiolitis and bronchial asthma are characterized by various widespread dry rales of a wheezing nature, which are subject to changes in different periods of time and phases of the disease. In addition, an attack of bronchial asthma is accompanied by wheezing with musical tones, which is expressed in the "playing accordion" syndrome. Tracheobronchitis, laryngitis and pharyngitis are characterized by a predominance of humming and buzzing wheezing. The invariability and constancy of dry wheezing suggests the presence of fibrosis or sclerosis of the lung, or a tumor formation that constantly compresses the bronchus.With the development of heart failure, dry rales over the lungs are heard, the transition of which to wet ones indicates the development of pulmonary edema.
Dry wheezing and other symptoms in various pathologies
The combination of dry wheezing with other symptoms in various pathologies is shown in the table.Thus, from the foregoing, we can conclude that wheezing is a complex symptom that occurs in various pathologies. The correct interpretation of all the characteristics of wheezing can help in early non-specific diagnosis, clarification of the localization of the pathological process, as well as in tracking the dynamics of the course of the disease. If wheezing occurs, you should undergo a comprehensive examination in order to receive a course of necessary therapy in time.
Which doctor should I contact for wheezing?
Wheezing can appear in diseases of various organs and systems, therefore, against the background of their presence, it is necessary to contact doctors of various specialties, whose competence includes the diagnosis and treatment of the pathology that provoked them. In addition, wheezing can be a symptom of an emergency, in which it is necessary to immediately go to the hospital to receive qualified medical care to save a life. Below, we will consider in which cases with wheezing you need to urgently seek medical help, and when you should go to the doctor as planned (and which specialist you need to contact).
So, it is urgent to call an ambulance and be hospitalized in the hospital with the following clinical pictures, including wheezing:
- When a person suddenly develops choking or paroxysmal choking cough, combined with wheezing or bubbling breath, with the release of foam from the mouth when breathing (often pink with an admixture of blood), with blue lips, nails and skin, cold sweat, increased pressure, puffiness of the face, palpitations, swelling of the veins in the neck (pulmonary edema is suspected).
- When a person develops shortness of breath with wheezing, combined with an almost complete absence of urination, diarrhea, nausea, vomiting, lethargy, drowsiness (acute renal failure is suspected).
- When a person develops wheezing, skin rashes, and digestive disorders after a blood transfusion, bone marrow transplant, or other transplant manipulation (an acute graft-versus-host reaction is suspected).
- When shortness of breath suddenly appears with rapid breathing and wheezing, which are combined with a pale gray or bluish color of the skin, a sharp drop in blood pressure, an increase in heart rate, bulging and pulsation of the veins in the neck, dizziness, tinnitus, vomiting, fainting, a slight increase in temperature body, belching, hiccups, pain under the right rib, possibly chest pain and arrhythmia (pulmonary embolism is suspected).
- When a dry cough occurs in combination with shortness of breath, chest pain, aggravated by coughing and breathing, high body temperature, headache, nausea, weakness, lag of one half of the chest during inhalation and exhalation (the formation of an abscess in the lungs is suspected). You should also immediately call an ambulance if, against the background of the described symptoms, a large amount of sputum suddenly begins to cough up (an abscess opening in the lung is suspected).
- When severe pain suddenly occurs in one half of the chest, combined with a dry cough, wheezing, shortness of breath, blue skin, a sharp drop in blood pressure and an increase in heart rate (pulmonary atelectasis is suspected).
- When a person breathes wheezing, combined with shortness of breath, pain in one half of the chest, possibly paroxysmal cough (a foreign body in the bronchus is suspected).
- When a person's body temperature rises to 39 - 40 o C, there is difficulty in breathing with wheezing or gurgling, shortness of breath, sore throat, nasal voice, cervical and occipital lymph nodes increase, the neck swells around the corner of the lower jaw (a retropharyngeal abscess is suspected).
So, if a person has a sudden increase in body temperature, pain and sore throat, runny nose, cough, aching muscles and joints, headache, weakness, then ARVI, influenza or parainfluenza is suspected, and in this case it is necessary to contact general practitioner (make an appointment) or pediatrician (make an appointment) when it comes to a child.
Wheezing is a symptom of many diseases of the respiratory system, in the presence of which it is necessary to contact pulmonologist (make an appointment) or a therapist. Below we provide a list of symptom complexes, including wheezing, in which it is necessary to contact a pulmonologist or therapist, since we are talking about diseases of the respiratory system:
- If a person periodically has attacks of suffocation, during which he feels tightness in the chest, which does not allow him to breathe freely, when loud whistling wheezes are heard during breathing, there is a cough with viscous poorly discharged sputum (bronchial asthma is suspected).
- If a person has wet rales, combined with a constant cough with the discharge of unpleasantly smelling purulent sputum, periodic hemoptysis, shortness of breath, cyanosis of the skin, general weakness, thickening of the nails like "watch glasses" and fingertips like "drumsticks", deformity of the chest (suspected bronchiectasis).
- If a person's body temperature rises, there is shortness of breath, wheezing, frequent shallow breathing, weakness, cough, first dry, and then with the discharge of "rusty" sputum (pneumonia is suspected).
- If a person, against the background of subfebrile body temperature (up to 37.5 o C), develops a cough with mucopurulent sputum, wheezing, shortness of breath, sweating, weakness, swelling of the cervical veins on exhalation (bronchitis is suspected).
- If a person suffers from a persistent cough with sputum production and shortness of breath, combined with wheezing, a bluish or gray-pink skin tone, a barrel-shaped chest (chronic obstructive pulmonary disease is suspected).
- If there is a dry obsessive cough, weakness, fever, whistling or moist rales audible at a distance, shortness of breath, cyanosis of the skin, and after a long course of the disease, panting breathing (bronchiolit is suspected).
- If a person develops shortness of breath, a dry cough that turns into a wet cough with sputum, wheezing, thickening of the fingertips like "drumsticks", a cyanotic skin tone, aching pain in the chest, weakness, deformity of the chest (pneumosclerosis is suspected).
- If it is difficult for a person to exhale, for which he closes his lips and puffs out his cheeks (puffs), wheezing is heard during breathing, there is a cough with the release of a small amount of mucous sputum, the face is puffy, the veins of the neck bulge, the skin is bluish in color, the chest is barrel-shaped (emphysema is suspected lungs).
- If a person develops cough, shortness of breath, wheezing, chest pain, skin rash, inflammation of the lymph nodes and salivary glands, malaise, weakness, lack of appetite, night sweats, sleep disturbances, possibly joint pain (sarcoidosis is suspected).
- If a child has dry or wet wheezing when breathing, periodically there are bouts of uncontrollable, suffocating cough (as with whooping cough), shortness of breath, deformity of the fingers and chest, prolonged frequent bronchitis and laryngitis, digestive disorders (mucoviscidosis is suspected).
Below we will indicate in which cases, with wheezing, a disease of the ears, throat or nose is suspected and, accordingly, it is necessary to contact otolaryngologist (ENT) (make an appointment):- When the voice becomes hoarse, discomfort and a feeling of a foreign object are felt in the throat, shortness of breath and wheezing appear, a round or oval painless protrusion forms on the neck (a laryngocele is suspected);
- When there is pain in the throat, perspiration and "lump", and the pain intensifies when swallowing, they are combined with a dry cough, accumulation of sputum in the throat and the need for constant coughing (pharyngitis is suspected);
- When the throat feels dry, scratching, combined with hoarseness or lack of voice (you can only speak in a whisper), barking cough and wheezing (laryngitis is suspected);
- If a person suffers from shortness of breath on inspiration for a long time (it is difficult to inhale), whistling rales are heard during breathing, his voice is hoarse and there are symptoms of hypoxia (oxygen starvation) of the brain, such as: poor memory, absent-mindedness, sleep disturbances, headaches, an attack of nausea (stenosis of the larynx is suspected).
When a person has non-specific signs of infection, such as fever, chills, headache, muscle and joint pain, skin rashes, sweating, which are combined with shortness of breath, wheezing and cough, then you should contact infectious disease doctor (make an appointment), since we are talking about a clearly infectious pathology (legionnaires' disease, endemic flea typhus), occurring with damage to the bronchopulmonary system.
If a person does not have a cough (with or without sputum) for more than 3 weeks, which is combined with sweating at night, subfebrile body temperature (up to 37.5 o C), weakness, weight loss, then you should contact phthisiatrician (make an appointment) because tuberculosis is suspected.
If for a long time a person has an irritating cough, wheezing, shortness of breath, sometimes hemoptysis, chest pain, as well as symptoms of a general deterioration in well-being (weakness, lethargy, poor performance, irritability, weight loss, headaches, etc.), then you should contact oncologist (make an appointment), as a bronchial tumor or lung cancer is suspected.
What tests and examinations can a doctor prescribe for wheezing?
Wheezing is provoked by various diseases, and therefore, in the presence of this symptom, the doctor prescribes various tests and examinations, the list of which depends on what kind of pathology is suspected. Below we will indicate which examinations a doctor can prescribe for wheezing if a particular disease is suspected.When a person’s body temperature suddenly rises, pain and sore throat, runny nose, cough, muscle aches, headache and weakness appear, the doctor diagnoses SARS, flu or parainfluenza, and in this case usually prescribes only complete blood count (make an appointment) and urine to assess the state of the body. Sometimes during a flu season, your doctor may order a blood test to look for the type of flu virus.
When, during periodic attacks of suffocation, during which it is difficult to breathe, loud wheezing, coughing and viscous poorly discharged sputum appear, the doctor suspects bronchial asthma and prescribes the following tests and examinations:
- General blood analysis;
- General sputum analysis (make an appointment);
- Biochemical blood test (sign up);
- Allergological tests (sign up) sensitivity to various allergens;
- Immune status (the number of immunoglobulins, the number of T and B-lymphocytes, etc.);
- Peakflowmetry (sign up);
- Spirometry (sign up);
- X-ray of the lungs (make an appointment);
- Electrocardiography (sign up);
- Bronchoscopy (make an appointment).
When moist rales are heard during breathing, combined with a constantly present cough with discharge of purulent sputum with an unpleasant odor, episodic hemoptysis, shortness of breath, pallor or cyanosis of the skin, deformity of the chest, thickening of the nails like "watch glasses" and fingertips like "drum sticks" - the doctor suspects bronchiectasis and prescribes the following tests and examinations:
- General blood analysis;
- Auscultation (listening with a stethophonendoscope) of the chest;
- Chest x-ray (book now);
- Bronchoscopy;
- Bacteriological culture (make an appointment) purulent secretion from the bronchi;
- Bronchography (X-ray of the bronchi with contrast) (make an appointment);
- Spirometry;
- Peakflowmetry.
When, against the background of high body temperature, wheezing, shortness of breath, weakness, cough (first dry, then with the release of "rusty sputum") appear, breathing becomes frequent and superficial - the doctor suspects pneumonia, and for its diagnosis, auscultation (listening to wheezing with a stethophonendoscope) and prescribes complete blood count and x-ray. It is the x-ray data that can confirm pneumonia. Additionally, a bacteriological culture of sputum is prescribed to identify the microbe that has become the causative agent of the infection.
When a person periodically has exacerbations with an increase in body temperature up to 37.5 o C, a cough with mucopurulent sputum, wheezing, shortness of breath, severe sweating, weakness, bulging neck veins on expiration, the doctor suspects bronchitis, and first performs auscultation ( listening to wheezing with a stethophonendoscope) and prescribes a chest x-ray. It is these two studies that are the main ones for the diagnosis of bronchitis. Next, microscopy and bacteriological culture of sputum are prescribed in order to identify the microbe-causative agent of the inflammatory process. If sputum is poorly excreted, then bronchoalveolar lavage is performed to collect it. To assess the function of external respiration, spirometry and pneumotachography are prescribed. If bronchitis proceeds for a long time, then bronchoscopy is prescribed to clarify the activity of the pathological process and identify the nature of inflammation, and bronchography is prescribed to detect bronchiectasis.
When there is a constant cough with sputum production, shortness of breath, wheezing, the skin is bluish or gray-pink in color, the chest is barrel-shaped - the doctor suspects chronic obstructive pulmonary disease (COPD), and for its diagnosis prescribes spirometry (the main method for diagnosing COPD), lung x-ray, complete blood count and blood gas analysis. Additionally, to assess the severity and nature of inflammation, a cytological examination of sputum and bronchoscopy may be prescribed.
When a dry obsessive cough is combined with weakness, whistling or wet rales, well audible even at a distance, with shortness of breath, body temperature, and after a long course of the disease and with cyanosis of the skin and puffing breath, the doctor suspects bronchiolitis and prescribes the following tests and examinations:
- Blood gas analysis;
- chest x-ray;
- Chest tomography;
- Spirometry;
- Determination of nitric oxide in exhaled air;
- electrocardiography;
- Echocardiography (make an appointment);
- Cytology of bronchoalveolar lavage;
- Histological examination lung tissue biopsy (make an appointment).
When a person is worried about shortness of breath, combined first with a dry and then a wet cough, wheezing, thickening of the fingertips like "drumsticks", a bluish tint of the skin, aching chest pains, weakness, a change in the shape of the chest, the doctor suspects pneumosclerosis, and for its diagnosis appoints an x-ray. If there is a technical possibility, then in order to obtain a more detailed idea of the state of tissues in pneumosclerosis, tomography and bronchography are also prescribed. To assess external respiration, the doctor must prescribe spirometry and peak flowmetry.
When a person exhales through closed lips while puffing out his cheeks (puffs), suffers from a cough with a small amount of mucous sputum, has shortness of breath, wheezing, a puffy face, bulging neck veins, a barrel-shaped chest and a bluish tint to the skin - the doctor suspects emphysema, and for its diagnosis, he performs auscultation (listening to wheezing and breathing with a stethophonendoscope), prescribes an x-ray, a general blood test, a blood test for the concentration of alpha1-antitrypsin, spirometry, peak flowmetry and blood gas analysis. Additionally, for more detailed information, it can be assigned computed tomography of the lungs (make an appointment).
When there is cough, wheezing, shortness of breath, chest pain, rashes on the skin, malaise, weakness, lack of appetite, sweating at night, sleep disturbances, lymph nodes and salivary glands become inflamed, joint pain may appear - the doctor suspects sarcoidosis and prescribes the following analyzes and examinations:
- General blood analysis;
- Biochemical analysis of blood (total protein, protein fractions, bilirubin (sign up), cholesterol, urea, creatinine, AST, ALT, amylase, alkaline phosphatase);
- Kveim's reaction;
- X-rays of light;
- Tomography (computer or magnetic resonance (sign up)) lungs;
- Bronchoscopy with biopsy (make an appointment).
When wheezing is heard in a child during breathing, combined with bouts of suffocating cough, shortness of breath, prolonged and frequent bronchitis and laryngitis, deformity of the fingers and chest, and digestive disorders, the doctor suspects cystic fibrosis, and for its diagnosis prescribes the following studies:
- General blood analysis;
- General urine analysis ;
- Microbiological examination of sputum;
- Scatological analysis of feces;
- Bronchoscopy;
- Bronchography;
- X-rays of light;
- Spirometry;
- sweat test;
- Testing blood, saliva, or other biological material for the presence of cystic fibrosis genes.
If a person’s voice becomes hoarse, shortness of breath, wheezing, a feeling of discomfort and a foreign object in the throat appear, and a protrusion forms on the neck, painless when touched, the doctor suspects a laringocele and prescribes the following tests and examinations:
- General blood analysis;
- Laryngoscopy (make an appointment);
- Endofibrolaryngoscopy;
- X-ray of the neck (make an appointment);
- Tomography (computer or magnetic resonance (sign up)) neck.
If a person has a sore throat and a sensation of a "lump" in the throat, sore throat, aggravated by swallowing, combined with a dry cough, the need for periodic coughing to remove the mucus accumulating in the throat, then the doctor suspects pharyngitis, and to diagnose it, he performs pharyngoscopy (make an appointment), and also prescribes a bacteriological culture of a swab from the pharynx to identify the microbe-causative agent of the inflammatory process.
If dryness is felt in the throat, scratching in combination with a barking cough, wheezing, hoarse or absent voice - the doctor suspects laryngitis, and to diagnose it, he performs laryngoscopy, and also prescribes a sputum culture to identify the causative agent of the infectious and inflammatory process.
When for a long time a person inhales the air with difficulty, and whistling rales are heard during breathing, his voice is hoarse, and these disorders are accompanied by signs of brain hypoxia (poor memory, absent-mindedness, sleep disturbances, headaches, bouts of nausea) - the doctor suspects stenosis of the larynx, and prescribes laryngoscopy or microlaryngoscopy with biopsy sampling to detect it. To assess the voice function, phonetography is prescribed and carried out. These surveys allow you to directly identify the stenosis of the larynx, but to find out the reasons for the narrowing of this organ, the doctor prescribes the following examinations:
- Ultrasound of the thyroid gland (make an appointment);
- Multislice tomography of the larynx;
- X-ray of the esophagus (make an appointment);
- Computer (sign up) or magnetic resonance imaging of the brain (make an appointment);
- Bacteriological culture of a throat swab.
When wheezing is heard during breathing, combined with pain in the heart, a feeling of interruptions in the work of the heart, palpitations or arrhythmia, shortness of breath during physical or emotional stress, dry cough, swelling in the legs
- General blood analysis;
- Blood test for antibodies (sign up) to rickettsiae (diagnosis of endemic flea typhus) by the methods of RSK, RA, RIGA, RIF, ELISA;
- Bacteriological culture of sputum or swabs from the bronchi (diagnosis of Legionnaires' disease);
- Analysis of blood, bronchial swabs or pleural fluid for the presence of antibodies to legionella by RIF, ELISA, RNIF, RMA (diagnosis of legionnaires' disease);
- X-rays of light.
When a cough (dry or with sputum) does not go away for more than 3 weeks, is combined with sweating at night, weight loss and persistent subfebrile body temperature (up to 37.5 o C), the doctor suspects tuberculosis and prescribes a complete blood count and sputum microscopy for the detection of mycobacteria. Next, any of the following tests is prescribed to detect Mycobacterium tuberculosis in the body - Mantoux test (sign up), diaskintest (sign up), quantiferon test (sign up), analysis of blood, swabs from the bronchi, pleural fluid by the method PCR (sign up). To detect changes in the lungs is prescribed fluorography (sign up), x-ray or computed tomography (one thing). And only if these studies did not allow unambiguously to refute or confirm tuberculosis, then additional diagnostics is prescribed thoracoscopy (make an appointment)/bronchoscopy and sampling of lung biopsy for histological examination.
When for a long period of time a person suffers from an irritating cough, wheezing, shortness of breath, sometimes hemoptysis, chest pain and symptoms of general poor health (decreased performance, constant fatigue, lethargy, weight loss, irritability, headaches, etc.) , then a tumor formation in the bronchi or lungs is suspected, and in this case, the doctor must prescribe the following tests and examinations:
- General blood analysis;
- Blood chemistry;
- Ionogram of blood;
- General urine analysis;
- Cytological examination of sputum, bronchial swabs or pleural fluid;
- chest x-ray;
- Chest tomography;
- Bronchoscopy;
- Biopsy of neoplasm tissue (sign up) for histological examination.