Wheezing and Asthma – Clinical Methods

Definition

A wheeze is a high-pitched, musical, adventitious lung sound produced by airflow through an abnormally narrowed or compressed airway(s). A wheeze is synonymous with a high-pitched or sibilant rhonchus.

Asthma is a heterogeneous syndrome characterized by variable, reversible airway obstruction and abnormally increased responsiveness (hyperreactivity) of the airways to various stimuli. The syndrome is characterized by wheezing, chest tightness, dyspnea, and/or cough, and results from widespread contraction of tracheobronchial smooth muscle (bronchoconstriction), hypersecretion of mucus, and mucosal edema, all of which narrow the caliber of the airways. The resulting airflow obstruction may be chronic or episodic, with respiratory symptoms resolving either spontaneously or as a result of therapy (bronchodilators or corticosteroids). A generally accepted definition of asthma does not yet exist because the syndrome has different causes, mechanisms, clinical features, and responses to therapy.

Technique

Wheezing is a subjective complaint that may be described in various ways. Some patients report noisy, difficult breathing (wheezy dyspnea), whereas others describe a whistling type of breathing or rattling secretions in the throat. The majority of asthmatic patients who report active wheezing generally have this finding documented by the examining physician. Nevertheless, wheezing is not always present during active asthma, and its absence should not exclude the diagnosis. Some patients with chronic asthma may become accustomed to wheezing and do not volunteer this information unless specifically asked. Most patients with asthma complain more frequently about chest tightness (in combination with shortness of breath or cough) than wheezing. Thus, any patient with chronic or episodic respiratory symptoms or who presents with a history of asthma or other chronic airway disease should be asked about wheezing.

The diagnosis of asthma is usually obvious from the patient’s history. It should be highly suspected from a description of episodic and variable respiratory symptoms (with or without wheezing) or recurrent chest colds and bronchitis (productive cough). A careful, thorough history is fundamental not only in arriving at an accurate diagnosis but also in determining the severity of an individual’s asthma and its appropriate therapy. The clinician should inquire about the following:

General (relating to the overall course of asthma in an individual):

• Age of onset of asthma

• Continuous or intermittent, with or without medications

• Usual precipitating factors ()

• Environmental survey (e.g., allergens, occupational or home exposures, smoking, air pollution)

• Medications, past and present, for asthma, noting the name or type of drugs, dosages, frequency, side effects, and compliance

• Related disability (e.g., time lost from work, school, or recreation)

• Frequency of visits to a physician or emergency room for asthma

• Frequency of hospitalizations, including any intubation and mechanical ventilation

• Associated medical conditions, (e. g., nasal polyps, sinusitis, allergies, gastroesophageal reflux, infection, psychological stress, and disorders that may simulate asthma)

• Personal and family history of asthma, atopy (allergic rhinitis, hay fever, eczema), positive skin tests for allergens, immunotherapy

Table 37.1

Contributing or Precipitating Factors in Asthma.

Specific (relating to acute episode in an individual):

• Frequency, duration, intensity of attacks

• Time of onset (e.g., morning or night, following exposure to a medication, food, or other substances)

• Possible causes (e.g., viral upper respiratory tract infection, exercise, emotional stress)

• Presence of complicating factors (e.g., fever, chest pain, sputum production, vomiting)

• Use of medications during attacks and symptomatic response, if any

Basic Science

Wheezing may result from localized or diffuse airway narrowing or obstruction from the level of the larynx to the small bronchi. The airway narrowing may be caused by bronchoconstriction, mucosal edema, external compression, or partial obstruction by a tumor, foreign body, or tenacious secretions. Wheezes are believed to be generated by oscillations or vibrations of nearly closed airway walls. Air passing through a narrowed portion of an airway at high velocity produces decreased gas pressure and flow in the constricted region (according to Bernoulli’s principle). The internal airway pressure ultimately begins to increase and barely reopens the airway lumen. The alternation of the airway(s) between nearly closed and nearly open produces a “fluttering” of the airway walls and a musical, “continuous” sound. The flow rate and mechanical properties of the adjacent tissues that are set into oscillation determine the intensity, pitch, composition (monophonic or polyphonic notes), duration (long or short), and timing (inspiratory or expiratory, early or late) of this dynamic symptom and sign. Wheezes are heard more commonly during expiration because the airways normally narrow during this phase of respiration. Wheezing during expiration alone is generally indicative of milder obstruction than if present during both inspiration and expiration, which suggests more severe airway narrowing. However, most asthmatic patients are unable accurately to correlate their wheezing (or other respiratory symptoms) to the severity of airway obstruction as measured objectively by pulmonary function tests.

In contrast, the absence of wheezing in an asthmatic may indicate either improvement of the bronchoconstriction or severe, widespread airflow obstruction. The latter suggests that the airflow rates are too low to generate wheezes or the viscous mucus is obstructing large regions of the peripheral airways. Increasing exhaustion and a “silent chest” are ominous signs of respiratory muscle fatigue and failure, leading to status asthmaticus.

In asthma, the markedly increased airway resistance (airflow obstruction) contributes to the characteristic physiologic and clinical changes observed during active or symptomatic periods. The airway obstruction is diffuse and nonuniform in distribution, resulting in ventilation–perfusion inequalities and hypoxemia. Airways tend to close early during expiration, and hyperinflation results. Although breathing at high lung volumes tends to maintain open airways, this response demands increased muscular work of breathing to provide adequate ventilation, which is increased secondary to stimulation of airway receptors and hypoxia. Most asthmatics complain of greater difficulty during inspiration than expiration, due to the uncomfortable work of breathing necessary to ventilate hyperinflated, abnormally stiff, or noncompliant lungs.

Several hypotheses have been proposed to explain the pathogenesis of bronchoconstriction and other airway abnormalities in asthma. None completely accounts for all the clinical forms of asthma. The proposed mechanisms probably overlap and interrelate even in the same individual.

The immediate, type I immunologic reaction occurs primarily in “allergic” asthma and involves biochemical reactions between an antigen and a specific antibody (immunoglobulin E, IgE) bound to sensitized airway mast cells and basophils. This immunologic reaction results in the release of potent biochemical mediators that contract bronchial smooth muscle, increase vascular permeability and mucus secretion, and attract inflammatory cells.

Preformed histamine, neutrophil and eosinophil chemotactic factors, and platelet-activating factors are released. In addition, membrane-associated oxidative metabolism of arachidonic acid generates prostaglandins (PGF₂α and PGD₂) and leukotrienes (LTC₄, D₄, E₄), which are potent bronchoconstrictors. Type III (arthus) immunologic reactions have also been implicated in some cases of asthma and in the related allergic bronchopulmonary aspergillosis.

A neurogenic or reflex mechanism is observed in “nonallergic” asthma provoked by nonspecific stimuli (e.g., exercise, infection, air pollution) that apparently do not initiate type I immunologic responses. This nonimmunologic hypothesis stresses the importance of the parasympathetic nervous system (vagus nerve) in regulating airway caliber. Chemical or mechanical inflammation stimulates cholinergic irritant receptors in the airway mucosa to hyperreact, leading to vagally mediated reflex bronchoconstriction. This reflex is produced by either direct mediator release or secondary stimulation of irritant receptors by smooth muscle constriction.

A partial beta-adrenergic blockade or deficiency has also been proposed to explain some types of “nonallergic” asthma (e.g., propranolol-induced asthma) because bronchial smooth muscle tone appears to be modulated by beta-adrenergic receptors and alterations in the metabolism of intracellular cyclic nucleotides. Beta-adrenergic stimulation increases cyclic 3,5-adenosine monophosphate (AMP) and decreases cyclic 3,5-guanosine monophosphate (GMP), resulting in smooth muscle relaxation (bronchodilation). Beta-adrenergic inhibition produces opposite effects, resulting in bronchoconstriction. Therefore, asthmatics may have relative beta-adrenergic hyporesponsiveness and an imbalance between adrenergic and cholinergic regulation that favor the latter, resulting in greater than normal mediator generation and unopposed bronchoconstriction.

Clinical Significance

Although most patients presenting with acute asthma can be readily recognized and diagnosed, the clinician must always be cognizant that “all that wheezes is not asthma.” Almost any respiratory disorder that leads to airway narrowing or obstruction can be associated with wheezing. The differential diagnosis of wheezing is long () and, at times, complicated, particularly if asthma coexists with another pulmonary disease.

Table 37.2

Differential Diagnosis of Wheezing.

Wheezing may be acute or chronic (recurrent) in children with nonasthmatic disorders. Acute wheezing in small children suggests bronchiolitis, particularly if the child was well prior to an upper respiratory tract infection (frequently respiratory syncytial virus) and has relatively irreversible airway obstruction without evidence of atopy. Many children with acute bronchiolitis may develop asthma; the long-term course of the illness may be the best diagnostic determinant because bronchiolitis does not usually recur. In a child, wheezing that is most prominent during inspiration suggests laryngotracheobronchitis (croup), epiglottitis, aspiration of a foreign body, or congenital laryngeal or tracheal narrowing. Wheezing occurs during both inspiration and expiration as the airway caliber becomes increasingly smaller. Wheezing may become confused with stridor, which is a high-pitched musical or “crowing” sound localized in the larynx or trachea. Chronic wheezing and respiratory infections in a child should raise the possibility of cystic fibrosis, with or without gastrointestinal complaints.

Adults with a new onset of wheezing generally have different nonasthmatic disorders from those in children. In adults, stridor or localized wheezing may be caused by mechanical obstruction of a central airway, such as by a tumor, foreign body (especially food), goiter, or stenosis. In addition to laryngeal edema (resulting from angioedema or anaphylaxis) and vocal cord paralysis, some individuals may have spastic adduction of the vocal cords due to functional or psychological factors. Wheezing in combination with productive cough and/or exertional dyspnea is not infrequent in chronic bronchitis or emphysema. Some patients may have increased wheezing during the early morning hours (“nocturnal asthma”) as a result of congestive heart failure with pulmonary edema (“cardiac asthma”), gastric aspiration, or sinusitis in which the recumbent position during sleep promotes pulmonary sequelae. Transient wheezing occurs in some patients with pulmonary embolism, the carcinoid syndrome, and systemic mastocytosis as a result of the release of bronchoactive amines or mediators. Parenchymal lung disorders such as sarcoidosis, extrinsic allergic alveolitis, and the adult respiratory distress syndrome (non-cardiogenic pulmonary edema) can occasionally produce wheezing due to airway compromise by granulomas or edema fluid, release of mediators, or underlying asthma. A large group of diseases characterized by pulmonary infiltrates and peripheral blood eosinophilia may produce asthma-like wheezing: Loeffler’s syndrome, chronic eosinophilic pneumonia, tropical eosinophilia, hypereosinophilic syndrome, various vasculitides, and allergic bronchopulmonary aspergillosis.

The heterogeneity and complexity of asthma are most apparent when one attempts to classify the various forms of this syndrome (). Different categories of asthma represent a clinical spectrum, and the majority of patients have features of several forms. For example, although “extrinsic” and “intrinsic” asthma are popular conceptual terms, many asthmatics do not conform to either category, and some may develop intrinsic asthma after many years with extrinsic features.

Table 37.3

Classification of Asthma.

Extrinsic (allergic) asthma commonly occurs in young patients who have other allergic or atopic disorders, as well as a family history of asthma and/or atopy. A specific, often seasonal antigen characteristically produces a type I hypersensitivity reaction, resulting in paroxysmal bronchoconstriction. Eosinophils in the sputum, eosinophilia, increased IgE, and positive skin tests for immediate hypersensitivity are common findings.

Intrinsic (nonallergic or infective) asthma occurs primarily in adulthood (more than 30 years of age) and is not usually associated with atopy, seasons, eosinophilia, increased IgE, or positive skin tests. These patients are hyperreactive to a wide variety of stimuli and have some intrinsic abnormality of bronchomotor tone. In many patients the onset of asthma is preceded by an upper respiratory infection, and asthmatic symptoms tend to persist for years with variations in severity rather than asymptomatic remissions.

Asthmatic bronchitis occurs in elderly, nonatopic patients who have a long or heavy smoking history and active chronic cough and sputum production with superimposed hyperreactive airways. The latter is supported by partial reversal of airway obstruction by bronchoconstriction during inhalation challenge with methacholine or histamine. Sinusitus and sputum rich in polymorphonuclear leukocytes (rather than eosinophils) are frequently present. Allergy evaluation is negative.

Exercise-induced asthma occurs in the majority of asthmatic patients who exercise (e.g., running, cycling). Wheezing and dyspnea characteristically develop shortly after completion of a sustained physical activity and may be the only symptoms of asthma. The severity of the symptoms depends on the duration and type of exercise and how recently the individual previously exercised. This phenomenon is caused by respiratory heat or water loss, which then releases mast cell mediators.

Drug-induced asthma occurs in patients shortly after exposure to certain medications (e.g., propranolol, timolol, aspirin, nonsteroidal anti-inflammatory agents, cholinergic drugs), additives (e.g., tartrazine, metabisulfite, alcohol), or certain medical procedures (e.g., studies using iodinated radiographic contrast dyes, hemodialysis). A patient with wheezing temporally related to aspirin ingestion, rhinitis, and nasal polyps suggests aspirin hypersensitivity. Foods may also contain potentially asthmagenic chemicals, such as monosodium glutamate and bisulfite preservative. In general, asthma related to these agents does not appear to have an immunologic mechanism and is more frequent in adult, nonatopic asthmatic patients.

Occupational asthma may be provoked in susceptible individuals following exposure to irritants present in a work setting or at home. The list of occupations and related asthmagenic substances used or generated is long and continually expanding. A further discussion is presented in Chapter 41, Environmental Inhalation.

Variant or atypical asthma occurs in some patients who present without wheezing but with acute or chronic cough or dyspnea as the sole symptom of asthma. Paroxysms of cough or dyspnea may or may not be related to a specific stimulus, season, time of day, activity, postnasal drip, or respiratory infection. Asthmatic patients with cough as the major or only symptom develop bronchoconstriction localized primarily in the central or large airways where subepithelial cough receptors abound and reflex bronchoconstriction occurs following exposure to various stimuli. Patients complaining of episodic dyspnea have involvement predominantly in the peripheral airways where bronchoconstriction, mucosal edema, and secretion contribute to the airway obstruction. Although most patients with atypical asthma are adults, the physical examination and routine pulmonary functions tests are not helpful (usually normal), making the diagnosis difficult and confusing. The diagnosis must begin with a high index of suspicion. It is supported by the patient’s response during an inhalation challenge with methacholine or histamine and/or an empirical trial of bronchodilators. This subgroup of asthmatics emphasizes the fact that wheezing is not always a cardinal manifestation of asthma.

References

1. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis. 1987;136:225–44. [PubMed: 3605835]

2. Boushey HA, Holtzman MH, Sheller JR. et al. Bronchial hyper-reactivity. Am Rev Respir Dis. 1980;121:389–413. [PubMed: 6987924]

3. Edelson JD, Rebuck AS. The clinical assessment of severe asthma. Arch Intern Med. 1985;145:321–23. [PubMed: 3977493]

4. Forgacs P. Lung sounds. London: Bailliæere Tindall, 1978;44–54.

5. Lawlor GJ Jr, Tashkin DP. Asthma. In: Lawlor GJ Jr, Fischer TJ, eds. Manual of allergy and immunology: diagnosis and therapy. Boston: Little, Brown, 1981; 113–56.

6. McFadden ER Jr,, Ingram RH Jr. Exercise-induced airway obstruction. Ann Rev Physiol. 1983;45:453–63. [PubMed: 6342521]

7. Shim CS, Williams H Jr. Relationship of wheezing to the severity of obstruction in asthma. Arch Intern Med. 1983;143:890–92. [PubMed: 6679232]

8. Statement by the Committee on Diagnostic Standards for Nontuberculous Respiratory Disease. Chronic bronchitis, asthma, and pulmonary emphysema. Am Rev Respir Dis. 1962;85:762–68.

9. Szczeklik A, Gryglewski RJ. Asthma and anti-inflammatory drugs. Mechanisms and clinical patterns. Drugs. 1983;25:533–43. [PubMed: 6409577]

10. *Weiss EB, Segal MS, Stein M, eds. Bronchial asthma. Mechanisms and therapeutics, 2d ed. Boston: Little, Brown, 1985.

11. Williams MH, Jr, Shim CS. Asthma. In: Simmons DH, ed. Current pulmonology. Chicago: Medical Year Book Publishers, 1985:6:267–305.

Sounds, causes, types, and more

Asthma wheezing is a whistling sound that happens when a person breathes through narrowed airway passages in the lungs.

It can occur after exposure to a trigger that causes swelling of the airway lining and tightening of the surrounding muscles. This can make breathing difficult.

People with asthma typically wheeze when breathing out, but some may also experience it when breathing in.

Treatment usually involves a combination of short and long-acting medications. The short-term drugs act quickly to alleviate wheezing and other asthma symptoms, while the long-term drugs stop the airways from narrowing, which helps prevent wheezing.

Asthma can have serious effects. It results in 439,000 hospitalizations and 1.3 million visits to the emergency room every year.

Keep reading to learn more about asthma wheezing, its treatment, and when to contact a doctor.

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.

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.

To discover more evidence-based information and resources for asthma & allergies, visit our dedicated hub.

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Wheezing breath: causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

Wheezing occurs when air is difficult to pass through the bronchi due to inflammation (edema), filling with sputum, dust, irritants or a foreign body entering the nasal cavity, larynx, main bronchi (most often in the right one due to the anatomical features of the tracheal division angle) into the two main bronchi).

The appearance of a whistle when breathing in newborns requires an immediate call to the doctor, even in the absence of other symptoms.

Lung diseases that may accompany wheezing:

1. Bronchitis (tracheobronchitis) – an inflammatory process in the bronchi (and trachea), accompanied by the appearance of sputum, often accompanies pneumonia. As a rule, with these diseases, not only “wheezing” occurs, but also cough, fever, weakness and a feeling of lack of air.
2. Pulmonary edema is a life-threatening condition that can occur in patients with a wide variety of pathologies and requires immediate hospitalization. It occurs due to the accumulation of extravascular fluid in the lungs, which disrupts gas exchange, sharply increases shortness of breath (violation of the frequency, depth and rhythm of breathing), the patient complains of a lack of air, sometimes foam from the mouth appears.
3. Bronchial asthma is characterized by chronic inflammation of the airways, attacks of suffocation, severe shortness of breath, whistling occurs during breathing, audible at a distance, cyanosis of the lips and nasolabial triangle may appear (the latter is typical for children).

The paroxysmal course of bronchial asthma requires a mandatory visit to the doctor.

4. Influenza is an acute viral disease that may be accompanied by the appearance of wheezing when breathing (in severe cases), which can be explained by the addition of a bacterial infection with the development of bronchitis or a viral lesion of the larynx with its edema.
5. Enlargement of the thyroid gland (diffuse or nodular goiter, thyrotoxicosis) may cause wheezing when breathing, talking or coughing due to compression of the larynx.
6. Allergic reactions, which are accompanied by the development of edema of the respiratory tract, angioedema (extensive swelling of the skin, subcutaneous tissue, mucous membranes and in some cases can cause suffocation), anaphylactic shock (the most severe manifestation of an allergic reaction), bronchospasm, are manifested by wheezing and require an ambulance help.
7. Lung and neck masses of various nature can compress the airways and cause wheezing.

Adverse environmental factors that can cause wheezing:

1. Work in hazardous industries (mining, glass and ceramics production, work in foundries and mines).
2. Stay in rooms or areas with air polluted with dust or vapors of harmful substances (gasoline, exhaust gases, etc.).
3. Contact with chemicals and other irritants.
4. Smoking (active and passive).
5. Taking certain drugs with bronchospasm side effects (for example, beta-blockers used to treat certain heart conditions).
6. Ingestion of a foreign body into the upper respiratory tract (nasal cavity, larynx).
7. Medical procedures that cause irritation of the bronchial wall (bronchoscopy, tracheal intubation, etc.).
8. Stress, nervous tension, hysteria.

Which doctors to contact

If wheezing occurs (if it is not associated with a life-threatening condition), it is necessary to contact
therapist who will refer the patient to a specialized specialist –
cardiologist
pulmonologist, infectious disease specialist or allergist.

Diagnostics

In diseases of the respiratory system (bronchitis, pneumonia), with pathological formations in the chest, X-ray of the chest organs and computer are indispensable for diagnosis.

Plain chest x-ray

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Laboratory diagnostics includes a general blood test with counting the number of leukocytes, sputum culture

Culture of sputum and tracheobronchial washings for microflora with the determination of sensitivity to an extended spectrum of antimicrobial drugs and smear microscopy

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(in its absence, culture of the bronchial discharge is used, which is taken during bronchoscopy) to identify the causative agent of the infection and determine its sensitivity to antibiotics, as well as its general analysis (microscopy) to identify atypical cells.

Sputum examination

The success of cytological diagnosis depends on the correct collection of sputum and its processing. For analysis, one should take a morning portion of sputum, coughed up pain …

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Carrying out sputum culture greatly facilitates the treatment process, because. makes it possible to prescribe antibiotics directly to the causative agent of the infection, which reduces the time of illness.

If neoplasms are detected in the chest organs, you should contact an oncologist, who, depending on the results of the examinations (chest x-ray, chest computed tomography)

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CT scan of the chest and mediastinum

Examination that provides data on the state of the chest and mediastinum.

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will select the required volume and type of treatment and, if necessary, appoint consultations of related specialists.

If a foreign body is suspected in the upper respiratory tract, X-ray of the paranasal sinuses or computed tomography of the paranasal sinuses is used to confirm the diagnosis.

X-ray of the paranasal sinuses

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CT scan of the paranasal sinuses

Examination that allows to detect various pathologies of the ENT organs.

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If a foreign body has entered the bronchi, then for diagnosis they resort to bronchoscopy, X-ray of the chest organs,

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in children, in addition, for a more complete examination, gastroscopy and radiography of the chest organs with contrasting of the esophagus can be performed.

Gastroscopy

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Treatment of bronchial asthma
pulmonologist. Spirometry is performed to determine the degree of violation of the ventilation function of the lungs, which helps the doctor in deciding whether to prescribe the necessary therapy, as well as to monitor the effectiveness of treatment.

With the development of pulmonary edema, after the elimination of a life-threatening condition, it is necessary to turn to
a cardiologist who will prescribe a series of examinations: echocardiography, ECG.

Echocardiography

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ECG interpretation

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Laboratory diagnostics includes determining the level of cholesterol, the lipid spectrum of total protein, and some other indicators.

Lipid profile: extended

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Total protein (in the blood) (Protein total)

Synonyms: Total protein in blood serum; Total whey protein.
Total Protein; Serum Total Protein; Total Serum Protein; TProt; TR.
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If the development of “wheezing” is presumably associated with taking medications, then it must be remembered that self-cancellation of medications is unacceptable and it is necessary to consult a doctor to change therapy.

Diseases of the thyroid gland, which are associated with its increase and possible deformation of nearby organs (diffuse-toxic goiter, autoimmune thyroiditis) are also manifested by hyperfunction of the gland. In this case, hair loss (up to baldness), increased sweating, protrusion of the eyeballs due to swelling of the paraorbital tissue (adipose tissue that is behind the eyeballs), and an increase in heart rate can be observed. If you suspect a thyroid disease, you should contact
an endocrinologist who will prescribe the necessary laboratory blood tests: thyroid hormones (T3 – triiodothyronine, T4 – thyroxine)

Triiodothyronine total (T3 total, Total Triiodthyronine, TT3)

Synonyms: Total triiodothyronine; General T3.

Triiodothyronine; T3 total test; T3 test.

Brief description of the test substance Triiodothyronine generic

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Total thyroxine (T4 total, total tetraiodothyronine, Total Thyroxine, TT4)

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Synonyms: Blood test for total thyroxine. Thyroxi…

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and their free fractions, the level of thyroid-stimulating hormone (which is produced in the anterior pituitary gland).

Thyroid Stimulating Hormone (TSH)

A pituitary hormone that regulates thyroid function. One of the most important tests in the laboratory diagnosis of thyroid diseases.

Synonym…

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For differential diagnosis, the doctor may use a set of laboratory tests (screening analysis or advanced).

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Thyroid gland: extended examination

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Treatment

For all inflammatory diseases of the chest, there are their own treatment protocols, which include the appointment of many drugs, including antibacterial ones. For their correct selection, a doctor’s consultation is necessary.

The treatment of bronchial asthma has its own characteristics and may include the appointment of various drugs, including hormonal drugs, there are special methods of physiotherapy and exercise therapy.

The treatment of heart failure is usually multicomponent and includes several drugs from different groups, the combination of which is determined by the cardiologist based on the results of the examination.

With the development of severe influenza, antiviral drugs and symptomatic treatment can be prescribed, which most often includes antipyretic drugs, drugs that thin sputum, vasoconstrictor drops in the nose from a runny nose, etc.

With the development of an allergic reaction with the appearance of wheezing, it is necessary to completely stop contact with the allergen (if possible), contact an allergist-immunologist to identify the causes of the condition. As a rule, antihistamines of various forms of release (drops, tablets or solutions for inhalation) are prescribed; in case of severe allergies, hormonal drugs may be prescribed.

Diseases of the thyroid gland are corrected by drugs that block the synthesis of T3, T4 hormones.

The selection of the dose of drugs, the determination of the need for their appointment should be handled exclusively by an endocrinologist under the control of the level of thyroid and pituitary hormones. To assess the effectiveness of therapy, ultrasound of the thyroid gland is performed.

If tumors of the lungs, larynx or upper respiratory tract are detected, the treatment may be different, depending on the localization and prevalence of the process: surgical removal of the tumor (most often in cases of a benign process), radiation and / or chemotherapy.

To remove foreign bodies that have entered the respiratory tract, an examination by an ENT doctor is most often sufficient, which can remove them directly during the examination.

However, when foreign bodies enter the bronchi, laryngoscopy or bronchoscopy is usually performed.

Sources:

1. Clinical guidelines “Bronchial asthma”. Developed by: Russian Respiratory Society, Russian Association of Allergists and Clinical Immunologists, Russian Union of Pediatricians. -2021.
2. Clinical guidelines “Bronchitis” (children). Developed by: Russian Union of Pediatricians, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, Russian Respiratory Society. – 2021.
3. Clinical guidelines “Chronic bronchitis”. Developed by: Russian Respiratory Society. – 2021.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

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Bronchial asthma – (Di Center clinics)

What is bronchial asthma

Bronchial asthma is a chronic inflammatory disease of the respiratory tract, manifested by attacks of shortness of breath, which are often accompanied by coughing and can develop into attacks of suffocation. This is due to the fact that the airways overreact to various stimuli. In response to irritation, they narrow and produce a large amount of mucus, which disrupts the normal flow of air during breathing.

Bronchial asthma occurs in people of all ages, but most often it manifests itself in children – half of them then “outgrow” their disease. Now more than 300 million people in the world suffer from this disease and their number is constantly increasing.

Due to the high prevalence of bronchial asthma, its ability to reduce work capacity and cause disability, there are many global and national programs to combat this disease. For example, in the UK, about a billion pounds a year is allocated for such a program. At the initiative of the World Health Organization (WHO), every year on May 4, World Asthma Day is celebrated.

Chronic inflammation, which is observed in patients with bronchial asthma, makes the airways sensitive to allergens, chemical irritants, tobacco smoke, etc. When exposed to them, swelling and spasm of the bronchi occur, at which point bronchial mucus is produced in large quantities. This makes it difficult for air to pass through the airways normally during breathing.

Depending on the cause of an asthma attack, asthma with a predominance of an allergic component and non-allergic asthma are distinguished.

An indicator that bronchial asthma is allergic in nature is that exacerbations occur upon contact with certain allergens (pollen, wool, house dust, some products), are seasonal. An attack of allergic asthma in a person is often accompanied by a runny nose, symptoms of autonomic dystonia, and urticaria.

In non-allergic asthma, the chronically inflamed airways are overly sensitive. Any irritation causes spasms of the bronchi, and the air flow through them is limited, which leads to coughing and asthma attacks.

There are many causes of an asthma attack. For example, pungent odors – tobacco smoke, household chemicals, soap, perfumes, exhaust fumes, etc. Researchers around the world came to a disappointing conclusion: every fifth asthmatic owes his illness to his profession.

Asthma symptoms may also appear within minutes of exercise—for example, exercise involving the inhalation of cold, dry air—such as jogging outside in winter. In such cases, one speaks of physical effort asthma.

An attack that occurs when taking aspirin or other anti-inflammatory drugs indicates the so-called aspirin asthma.

The cause of asthma caused by food additives can be, for example, the intake of sulfites (beer, wine preservatives).

If an attack develops both upon contact with an allergen and under the influence of other factors, asthma is called mixed. It is this form that is the most common, especially in the later stages of the disease.

In cases where asthma does not have a clear cause, it is called unspecified.

How does it manifest itself?

The most characteristic signs of bronchial asthma are:

• cough – can be frequent, painful and persistent. The cough may be worse at night, after exertion, after inhaling cold air;

• expiratory (with predominant difficulty in exhaling) shortness of breath – breathing can be so limited that it causes fear of being unable to exhale;

• whistling wheezing, audible at a distance – caused by the vibration of air with the force passing through the narrowed airways;

• suffocation.

In severe or acute bronchial asthma, a person breathes through the mouth during an attack, using the muscles of the shoulders, neck and torso to facilitate breathing through the narrowed airways. Also, when the airways are constricted, it is easier to breathe in than to breathe out. This happens because inhalation is a procedure familiar to our body, and the chest muscles are trained for this movement.

Exhalation, on the contrary, normally occurs passively, i.e. without special efforts, therefore the muscles are not sufficiently developed to remove air through the narrowed airways. As a result, air remains in the lungs, and they become swollen.

By the way, in young people who have been suffering from asthma for a long time, it is because of this that the so-called “pigeon chest” develops. In severe acute bronchial asthma, a previously “whistling” chest may become “mute”, without whistling sounds. This is because the amount of air inhaled and exhaled is so small that sounds cannot be heard.

Asthma diagnostics

After the manifestation of the first attacks of bronchial asthma, it is necessary to undergo an examination by a pulmonologist, who collects detailed information about the course and duration of the disease, working and living conditions, bad habits of the patient, and conducts a complete clinical examination.

Sometimes asthma attacks are difficult to distinguish from manifestations of other diseases. For example, pneumonia, bronchitis, heart attacks, pulmonary thrombosis, diseases of the vocal cords, tumors can also cause an acute attack of shortness of breath, choking and dry wheezing.

In the diagnosis of bronchial asthma, the study of lung function spirometry helps: for this, you will need to exhale air into a special device. A mandatory study is peak flowmetry – the measurement of the maximum expiratory flow rate. Then it will need to be carried out at home, using a portable peak flow meter. This is necessary for objective monitoring of the course of bronchial asthma and determining the required dose of the drug.

Laboratory methods in the diagnosis of bronchial asthma include blood and sputum tests.

With the help of X-ray and computed tomography of the lungs, the presence of infection, other lesions of the respiratory tract, chronic circulatory failure, or the ingress of a foreign body into the respiratory tract can be excluded.

You should also conduct a study with an allergist using skin tests with various allergens. This study is needed in order to determine what exactly can cause an attack.

Treatment of bronchial asthma

Bronchial asthma is a chronic disease that requires daily treatment.