Wheeze

WHEEZEDefinitionMechanismCauses

Izatty Lim0308188Batch 4

Palpable and audible vibrationsMusical in characterProduced when airflow is restricted

DEFINITIONThe American Thoracic Society Committee

Wheeze: High pitched continuous sounds with a dominant frequency of 400 Hz or more.

MC: expiratory wheezeTypically reflect lower airway obstruction

MC found with asthma & bronchiolitisOther causes: CHF & foreign body aspiration

http://www.stethographics.com/main/physiology_ls_wheeze.html https://www.youtube.com/watch?v=BvnphT1QnNY WHEEZEPolyphonicMonophonic Various pitch Single- pitch soundWidespread narrowing of airwaysNarrowing of larger airwaysAsthmaTracheomalacia, bronchomalacia

Airway NarrowingBronchoconstrictionMucosal edemaExternal compressionPartial obstruction by tumorforeign bodytenacious secretionMECHANISM

WheezeGenerated by vibrations/oscillations of nearly closed airway wallsAir passing through narrowed portion at high velocity gas pressure and flowAirway pressure slightly and barely reopens airway lumenAlternating between nearly closed and nearly open fluttering of the airway walls and a musical, continuous sound.

WheezeGenerated by vibrations/oscillations of nearly closed airway wallsAir passing through narrowed portion at high velocity gas pressure and flowAirway pressure slightly and barely reopens airway lumenAlternating between nearly closed and nearly open fluttering of the airway walls and a musical, continuous sound.

WheezeGenerated by vibrations/oscillations of nearly closed airway wallsAir passing through narrowed portion at high velocity gas pressure and flowAirway pressure slightly and barely reopens airway lumenAlternating between nearly closed and nearly open fluttering of the airway walls and a musical, continuous sound.

WheezeGenerated by vibrations/oscillations of nearly closed airway wallsAir passing through narrowed portion at high velocity gas pressure and flowAirway pressure slightly and barely reopens airway lumenAlternating between nearly closed and nearly open fluttering of the airway walls and a musical, continuous sound.

Wheezing occurs during the prolonged expiratory phase by the rapid passage of air through airways that are narrowed to the point of closure. Children wheeze more often than adults because of physical differences. Infants' and young children's bronchi are small, resulting in higher peripheral airway resistance. As a result, diseases that affect the small airways have a proportionately greater impact on total airway resistance in these patients. Infants also have less elastic tissue recoil and fewer collateral airways, resulting in easier obstruction and atelectasis. The rib cage, trachea, and bronchi are also more compliant in infants and young children, and the diaphragm inserts horizontally instead of obliquely. All of these factors increase the likelihood of wheezing and respiratory distress in both of these groups.2

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Toy trumpet sound is produced by a vibrating reed.

Pitch dependent on the mass and elasticity of the airway walls & on the flow velocity.

Wheeze production model collapsible tube the fluttering of airways walls & fluid together, induced by a critical airflow velocity.

Many circumstances are suitable for the production of continuous adventitious lung sounds. Thus, wheezes can be heard in several diseases, not only asthma.MECHANISM

Wheeze production model based on the mathematical analysis of the stability of airflow through a collapsible tube

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Viral infection

Asthma

Foreign body aspiration

Cystic fibrosis

Anatomic abnormalitiesTracheomalacia, bronchomalacia Mediastinal mass Congenital heart disease (R to L shunt)

GERD

Anaphylaxis

Causes of Wheeze

customized tracheal splints for each patient7

AsthmaForeign body aspirationBronchiectasisBronchiolitisBronchitisEmphysema (COPD), especially when a respiratory infection is presentHeart failure (cardiac asthma)Gastroesophageal refluxInsect sting that causes an allergic reactionMedications (particularly aspirin)PneumoniaSmokingViral infection, especially in infants younger than age 2Causes of Wheeze

www.aafp.org/aafp

Done! Thank you.

N M, al et. Wheezes. - PubMed [Internet]. 1995 [cited 2015 Jun 21]. Available from: http://www.ncbi.nlm.nih.gov/m/pubmed/8620967/

OBrien N, Gill D, Hickey D. Paediatric Clinical Examination Made Easy. Edinburgh: Churchill Livingstone Elsevier; 2007.

Zorc JJ, editor. Schwartzs clinical handbook of pediatrics. Philadelphia: Lippincott Williams and Wilkins; 2008.

Lissauer, Tom, Graham Clayden, and Alan Craft. Illustrated Textbook Of Paediatrics. Edinburgh: Mosby, 2012. Print.

Weiss LN. The Diagnosis of Wheezing in Children - American Family Physician [Internet]. [cited 2015 Jun 21]. Available from: http://www.aafp.org/afp/2008/0415/p1109.htmlReferences

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