Wheezing

WHEN TO SEE YOUR DOCTOR

* Wheezing is accompanied by shortness of breath, fast breathing or coughing up phlegm.

* You have a history of heart problems or chest pain, or your feet and legs are swollen.

* You have not been previously diagnosed with asthma.

* You have asthma and need to use your bronchodilator every four hours or more to prevent wheezing bouts.

What Your Symptom Is Telling You

Wheezing is the hallmark of asthma, an extreme sensitivity of the lungs that causes inflammation and constriction of the airways. "The airway walls are narrow from swelling and inflammation," says Michael S. Sherman, M.D., an assistant professor and medical director of the Department of Pulmonary Services in the Division of Allergy, Critical Care and Pulmonary Medicine at Hahneman University Hospital in Philadelphia. "The muscles also contract, squeezing the airways even more." That double dose of constriction also causes shortness of breath.

People with asthma don't go about with a constant wheeze. The constriction needs a trigger—but when your airways are supersensitive, it's a hair-trigger, according to Susan R. Wynn, M.D., an allergist in private practice with Fort Worth Allergy and Asthma Associates in Texas.

"Anything you can smell—fumes, cigarette smoke, perfume, even those little potpourris—can trigger wheezing in someone with asthma," she says. So can a long workout, which dries bronchial tissue and constricts the smooth muscles in the lungs. Add to the list allergies, infections and emotional stress.

But all that wheezes is not asthma. Infections as innocuous as a cold or as virulent as pneumonia can clog airways with mucus and cause wheezing in people without a history of asthma, says Dr. Sherman. The excess production of mucus from chronic bronchitis also constricts airways and produces a nasty wheeze (along with shortness of breath and rapid breathing). And wheezing is also a symptom of emphysema.

Asthma, emphysema and chronic bronchitis usually cause wheezing on the exhale. A wheeze or noise upon inhaling is usually caused by an obstruction in the upper part of the respiratory tract, according to Charles P. Felton, M.D., chief of pulmonary medicine at Harlem Hospital Center and a clinical professor of medicine at Columbia University College of Physicians and Surgeons in New York City.

In fact, any infection or swelling of the larynx or trachea can produce noisy breathing, called stridor, Dr. Felton says. So can inhaling an object—choking on a chicken bone or having food go down the wrong pipe. "Whatever the situation, stridor is always cause for alarm and needs immediate medical attention," he says.

And sometimes wheezing's main cause isn't a problem in the respiratory tract, upper or lower. A poorly functioning heart can't pump blood effectively through the lungs, which then fill up with fluid. The airways can narrow from fluid, causing a wheeze. "Additionally, when you inhale, the air hits the water, making almost a gurgling sound that doctors call 'rale' or 'crackle,' " says Dr. Sherman. How do you know if your wheeze is caused by a heart problem? Swelling in the feet or legs may be present.

Symptom Relief

If you're wheezing, you're not just whistling Dixie. "It's pretty serious stuff," says Dr. Wynn. If you haven't already been diagnosed with asthma and you don't have a cold, you should visit a doctor or the hospital emergency room, especially if the wheeze or rattle occurs when inhaling. Here are a few tips to make your life a little less wheezier.

Cough it away. If your wheeze disappears after a few coughs clear away some mucus, you probably have a cold or some other viral infection, says Dr. Sherman. A key to its severity will be the color of your mucus. Yellow is usually a sign of infection, and you may need a prescription for an antibiotic. If the mucus is clear or white, try some of the remedies in Coughing on page 109 and Sneezing on page 484. Those tips also will be helpful in dealing with asthma.

Give your lungs a wake-up call. Drinking two cups of caffeinated coffee can ease the wheeze of an asthma episode, according to Dr. Wynn. And if you're on your way to the doctor's office because of a bout of wheezing with an unknown cause, she says that it wouldn't hurt to drink a can of cola or a cup of coffee to see if it provides some relief.

Reduce lung inflammation. A couple of prescription drugs are particularly helpful for treating asthma-induced wheezing. The antihistamine cromolyn sodium or inhaled corticosteroids are now seen as the primary medications to reduce the inflammation that narrows airways in the lungs, doctors say. "You won't notice immediate relief," Dr. Wynn says. "It's more of a gradual improvement, but over time, the corticosteroids help reduce the inflammation and irritation of whatever is triggering the asthma."

Breathe with a bronchs accent. Prescription medications that dilate the bronchial tubes—bronchodilators like albuterol and metaproterenol—immediately relax airway muscles in the midst of an asthma flare-up, Dr. Sherman says. Bronchodilators also are more useful than corticosteroids to expand the airways of people with emphysema or chronic bronchitis.

Know the plan for an attack. Make sure your physician helps you to understand precisely what medications to take when your asthma flares up, Dr. Wynn says. "It'll be different for everybody," she says. "If you get a bout of wheezing, you'll know what to do and won't panic."

Leave the rest on the shelf. Because of side effects like high blood pressure, a rapid pulse and heart palpitations, doctors don't look too favorably on using over-the-counter preparations to treat wheeze sprees. If you know you have asthma and you have no other alternative at the time, you could take a puff of something like Primatene Mist that contains epinephrine.

If you have not been diagnosed with asthma, don't treat yourself with OTC drugs. "Don't waste your time with any of that," Dr. Sherman says. "You don't know what's causing the wheeze, and time could be of the essence. See your doctor."