What is asthma wheezing?

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Wheezing is a high-pitched whistling or squeaky sound that occurs when a person breathes through constricted airways.

Some people describe it as a musical sound from a wind instrument, but people describe it in many different ways.

In some cases, a person may not hear the wheeze, and a doctor may only identify it with a stethoscope during a physical examination of the lungs.

Asthma affects the airways, which are the tubes that transport air in and out of the lungs. When a person has asthma, the airways become overly reactive in response to triggers, such as certain allergens and irritants.

After exposure to a trigger, the following effects occur:

• swelling and inflammation of the lining of the airways
• accumulation of mucus that obstructs airflow
• constriction of muscles surrounding the airways
• the lungs have trouble moving air, particularly during expiration.

Consequently, the airways narrow, which produces symptoms, such as wheezing.

Inspiratory wheezing happens during an inhalation when a person breathes air into the lungs. Expiratory wheezing occurs during exhalation when a person breathes air out of the lungs.

The most common type of wheezing in asthma occurs during exhalation, but it can also happen during inspiration. In people with severe asthma, the extreme reduction of airflow may result in no audible wheezing.

Treatment of asthma wheezing depends on various factors, such as a person’s age, their response to medications, and the severity of their condition. Doctors prescribe both short-term and long-term medications for most people.

Short-term medications

These provide fast relief from wheezing and other symptoms of an asthma attack. If someone has mild symptoms, they may only require one of these medications to treat the symptoms.

Types of short-term medication include:

• Inhaled short-acting beta2-agonists (SABAs): These quickly relax muscle tightness around airways, which widens the passages and allows more airflow. Side effects include tremors and a fast heartbeat. An example is albuterol (Proventil).
• Inhaled short-acting anticholinergics: These rapidly open airways. They may not work as effectively as SABAs but may suit people who cannot tolerate their side effects. An example is glycopyrronium (Seebri Neohaler).
• Oral and intravenous (IV) corticosteroids: Oral administration means an individual takes the drug by mouth, while IV administration means they receive the drug through injection in a vein. These are options for severe wheezing and other asthma symptoms. An example is prednisone (Rayos).

Long-term medications

The daily use of long-term control medications helps lower inflammation and prevent narrowing in the airways. These effects can help reduce symptoms, including wheezing.

Types include:

• Corticosteroids: Doctors may prescribe these in oral or inhaler form, although the inhaler form is preferred. Common side effects from the inhaled form include thrush, which is a mouth infection, and hoarseness. Oral medications can cause more side effects because the bloodstream circulates them throughout the body.
• Inhaled long-acting bronchodilators: These prevent airways from narrowing. They include long-acting beta2-agonists, which doctors may prescribe with an inhaled corticosteroid. An example is salmeterol (Serevent).
• Leukotriene modifiers: These are oral drugs that lower inflammation and keep airways open. Sometimes doctors prescribe them with a corticosteroid. An example is montelukast (Singulair).
• Mast cell stabilizers: These help prevent inflammation of the airways following exposure to a trigger. An example is cromolyn (Gastrocrom).
• Biologic drugs: These are antibodies that target specific parts of the body’s response to allergens. Doctors prescribe them for people with severe asthma and administer them via an IV injection in a vein or below the skin. An example is omalizumab (Xolair).
• Immunotherapy: These lower the inflammatory response to allergens and are available in oral or injection form.

Emergency treatment for severe wheezing may include short-acting bronchodilators, steroids, and magnesium. In addition, a person may need oxygen therapy or ventilator support. Another option is heliox, a mixture of helium and oxygen, which can reduce turbulent airflow, making it easier for a person to breathe.

The American Lung Association (ALA) recommends calling a doctor quickly if a person wheezes when they inhale and exhale. This is particularly important if the wheezing pattern differs from someone’s usual breathing.

Also, if wheezing worsens even after a quick-acting medication has had time to work, which is about 15 minutes, it is time to call a doctor.

According to the ALA, an individual should call 911 or go to the emergency room if:

• their nails or lips are turning blue
• they are taking 30 or more breaths per minute
• their nostrils are flaring each time they inhale
• they experience difficulty in talking or walking at an average pace
• their skin between the ribs or at the base of the throat looks stretched in each inhalation

Asthma wheezing is a high-pitched whistling sound that happens when breathing through swollen, constricted airways. It most often occurs during exhalations.

Treatment varies and depends on a range of factors, such as a person’s age and the severity of their condition.

If someone has mild wheezing and other asthma symptoms, a short-acting inhaler may manage the condition. However, most people with asthma need a combination of short-acting and long-acting medications.

Severe cases of asthma can cause symptoms, such as a bluish tinge of the lips, that indicate an individual needs immediate treatment. When this happens, they should go to the emergency room because the condition can be life-threatening.