Wheezing: Causes, symptoms, treatment, Ayurveda Understanding

By Dr Manasa S, B.A.M.S

Wheezing, that shrill whistle or rattling breath, can signal a variety of respiratory issues, from simple irritants to complex underlying conditions. Audible both on inhale and exhale, its tone varies, reflecting the location of the obstruction in your airways.

While some wheezes whisper softly, others resonate with a musical quality akin to wind instruments.

From infants to elders, anyone can experience wheezing, but certain groups, like smokers, those with emphysema or heart failure, are more susceptible. Infants, with their delicate airways, often grapple with wheezing, especially in the face of viral infections. Meanwhile, asthma and allergies further heighten the risk, affecting both adults and children. Whether it’s a temporary response to dust or a symptom of a chronic condition, understanding wheezing is crucial for maintaining respiratory health.

Causes of wheezing

–        Chronic obstructive pulmonary disease (COPD)
–        Bronchitis
–        Pneumonia
–        Emphysema
–        Asthma
–        Bronchiolitis
–        Anaphylaxis
–        Respiratory tract infection
–        Bronchiectasis
–        Gastroesophageal reflux disease (GERD)
–        Heart failure
–        Lung cancer
–        Epiglottitis
–        Obstructive sleep apnea
–        Vocal cord dysfunction
–        Allergies
–        Smoking
–        Foreign object
–        Drugs (i.e., aspirin)
–        Respiratory syncytial virus (RSV)

Types of wheezing

Inspiratory and expiratory wheezing are the two types of wheezing commonly seen in clinical set up. Inspiratory wheezing happens when air is breathed in and expiratory wheeze happens when air is breathed out.

Inspiratory wheeze

–        It occurs during inhalation
–        When wheezing is heard over the lungs it is often inspiratory wheeze accompanied with expiratory wheeze
–        When inspiratory wheeze is heard over the neck, this shows that there Is a narrowing in the large, upper airways of the neck.
–        It is seen is asthmatic conditions

Expiratory wheeze

–        It occurs during expiration
–        It indicates narrowing in the small airways or a mild block or obstruction in all or part of the airway
–        It is commonly seen in conditions such as asthma but can be seen in other conditions of airway blockages
–        It indicates that there is a reduction in the rate of peak expiratory flow.

Other symptoms associated with wheezing

–        Shortness of breath
–        Feels like working harder to breath
–        Breathing is deeper, faster or heavy
–        Flaring of the nostrils or pulling of the skin above the collar bone or in between the ribs

Are there any risk factors involved in wheezing?

–        Hereditary illnesses, like asthma can run in families
–        Past and current smokers
–        Children in daycare or with older siblings, due to the increased exposure to infections
–        People who are allergic to pollens

Diagnostic tools

–        Physical examination to listen to the lungs for breath sounds
–        Pulse oximetry to measure the oxygen levels
–        Chest X-rays
–        Pulmonary function tests
–        Blood tests

When to seek emergency care for wheezing?

–        If someone is experiencing wheezing for the first time and underlying reason is not clearly known
–        If wheezing is accompanied with hives, difficulty in breathing and swollen face or throat.
–        Dizziness
–        Chest pain

Treatment for wheezing

Medications for Wheezing

Asthma Medications

–        Inhaler prescribed to reduce inflammation and open airways (bronchodilator).
–        Anti-inflammatory medicines like inhaled corticosteroids and montelukast (Singulair®).

Bronchitis Medications

–        Prescription of bronchodilators such as albuterol (Proair® HFA, Proventil® HFA, Ventolin® HFA).
–        Antibiotics for bacterial infection if applicable.

Other Treatments for Wheezing

–        ER or Healthcare Provider Visit
–        Oxygen therapy administered initially for severe wheezing.
–        Hospitalization might be required if wheezing persists despite oxygen therapy.

Specific Treatments for Other Causes

–        Tailored treatments like oxygen therapy depending on the underlying cause.

Preventive measures

–        Breathing exercises, including diaphragmatic breathing and deep breathing in a moist environment.
–        Drinking hot herbal tea, particularly green tea known for          antibacterial properties.
–        Avoiding smoking and second-hand smoke exposure.
–        Using air purifiers with HEPA filters to remove allergens.
–        Employing humidifiers or vaporizers to moisten the air.
–        Avoiding known allergy triggers.

Breathing exercises for wheezing

Pursed-Lip Breathing – This technique involves inhaling through your nostrils, as you would normally breathe. However, when exhaling, you purse your lips as if you were going to whistle. The exhalation should be done slowly and deliberately, lasting twice as long as your inhalation. This method helps to regulate breathing and can be particularly useful for managing stress and anxiety.

Belly Breathing – Also known as diaphragmatic breathing, this technique focuses on deepening your breath by engaging the diaphragm muscle. To practice belly breathing, start by inhaling deeply through your nose, allowing your abdomen to expand as you fill your lungs with air. You can place your hands on your abdomen to feel it rising. Then, exhale slowly through your mouth, ensuring that the exhalation lasts at least two to three times longer than your inhalation. This type of breathing promotes relaxation, reduces tension, and increases oxygenation of the body. It’s often recommended for stress relief and improving overall well-being.

Wheezing : Ayurveda Understanding

We do not get a lot of information about ‘abnormal breath / respiratory sounds’ in Ayurveda treatises. But whatever minimum references we get directly or by inference with special reference to ‘wheezing’ can be found in the contexts of –

1. Shwasa Roga – diseases presenting with difficulty in breathing as predominant symptoms. Example, Tamaka Shwasa presents with ‘ghur ghura ka shabd’ i.e. ‘wheezing’ or ‘rhonchi’ sounds. Similarly, the ‘intoxicated bull’ like breathing pattern of Maha Shwasa produces ‘rhonchi’ or ‘wheeze’.

2. Kasa Roga – diseases presenting with cough as predominant symptom.  Example – Kaphaja Kasa – may present with rhonchi and when complicated, may produce wheezing.

3. Pranavaha Sroto Dushti – symptoms of contamination or damage of channels responsible for transportation prana energy or oxygen / air.

Symptoms explained in this context covers a wide array of abnormal breath sounds including wheezing.

Related Reading – ‘Abnormal Breathing Sounds as explained in Ayurveda Treatises – Clinical significance’