Деякі причини свистячого дихання
Cause | Suggestive Findings | Diagnostic Approach* |
|---|---|---|
URI symptoms No known history of lung disease | Clinical evaluation | |
Allergic reaction | Sudden onset, usually within 30 minutes of exposure to known or potential allergen Often nasal congestion, urticaria, itchy eyes, sneezing | Clinical evaluation |
Often known history of asthma Wheezing arising spontaneously or after exposure to specific stimuli (eg, allergen, URI, cold, exercise) | Clinical evaluation Sometimes pulmonary function testing, peak flow measurement, methacholine challenge, or observation of response to empiric bronchodilators | |
In children < 18 months (usually from November to April in the Northern Hemisphere) Usually URI symptoms and tachypnea | Clinical evaluation | |
COPD exacerbation | In middle-aged or older patients Often known history of COPD Extensive smoking history Poor breath sounds Dyspnea Pursed lip breathing Use of accessory muscles | Clinical evaluation Sometimes chest x-ray and ABG measurement |
Drugs (eg, ACE inhibitors, aspirin, beta-blockers, NSAIDs) | Usually, recent initiation of a new drug, most often in a patient with a history of reactive airway disease | Clinical evaluation |
Endobronchial tumors | Fixed and constant inspiratory and expiratory wheezes, especially in a patient with risk factors for or signs of cancer (eg, smoking history, night sweats, weight loss, hemoptysis) May be focal rather than diffuse | Chest x-ray or CT Bronchoscopy (usually preceded by spirometry with flow volume loops that indicate obstruction) |
Foreign body | Sudden onset in a young child who has no URI or constitutional symptoms | Chest x-ray or CT Bronchoscopy |
GERD with chronic aspiration | Chronic or recurrent wheezing, often with heartburn and nocturnal cough No URI or allergic symptoms | Trial of acid-suppressing drugs Sometimes esophageal pH monitoring |
Sudden onset after occupational exposure or inappropriate use of cleaning agents | Clinical evaluation | |
Left-sided heart failure with pulmonary edema (cardiac asthma) | Crackles and signs of central or peripheral volume overload (eg, distended neck veins, peripheral edema) Dyspnea while lying flat (orthopnea) or appearing 1–2 hours after falling asleep (paroxysmal nocturnal dyspnea) | Chest x-ray ECG BNP measurement Echocardiography |
* Most patients should have pulse oximetry. Unless symptoms are very mild or are clearly an exacerbation of a known chronic disease, chest x-ray should be done. | ||
ACE = angiotensin-converting enzyme; BNP = brain (B type) natriuretic peptide; COPD = chronic obstructive pulmonary disease; GERD = gastroesophageal reflux disease; NSAID = nonsteroidal anti-inflammatory drug; URI = upper respiratory infection. | ||