What is wheezing?
Wheezing is a whistling or squeaky sound that occurs when you breathe, usually when air flows through narrowed breathing tubes. It’s one of the main symptoms of asthma, along with coughing, shortness of breath, and chest tightness. Wheezing occurs when the airways are inflamed, swollen, or constricted. As the air moves through these narrowed passages, it causes the wheezing sound. Some common causes of wheezing include:
- Asthma
- Allergies
- Respiratory infections
- Chronic obstructive pulmonary disease (COPD)
- Heart failure
- Lung cancer
- Pneumonia
Wheezing can range from mild to severe. In some cases, it may be barely noticeable, while in others it can be clearly audible. The pitch and intensity can vary too. Wheezing is often worse at night or early in the morning. Certain triggers can set off wheezing episodes, such as:
- Exercise
- Allergens like pollen or pet dander
- Irritants like cigarette smoke
- Cold air
- Respiratory infections
- Stress or anxiety
What happens when wheezing is left untreated?
If wheezing is left untreated, several complications can develop over time:
More frequent and severe asthma attacks
For people with asthma, untreated wheezing is a sign that the airways are chronically inflamed. Over time, this inflammation can worsen and lead to permanent airway changes. Patients may experience more frequent and more severe asthma attacks requiring emergency care.
Decreased quality of life
The chronic wheezing and breathing difficulties can significantly impact daily activities and quality of life. Simple physical tasks become challenging. Work and school absenteeism increase. Sleep quality suffers due to nighttime symptoms. Patients may limit activities and social interactions to avoid triggers.
Lung function decline
Chronic inflammation from untreated wheezing can cause structural changes in the lungs over time. This includes thickening of the airway walls and increased mucus production. Lung function declines as the airflow becomes increasingly obstructed.
Respiratory infections
Individuals who wheeze have hypersensitive airways that are more vulnerable to infections. The swollen, excess mucus-filled airways provide an environment for viruses and bacteria to thrive. Patients are at higher risk for respiratory illnesses like pneumonia, bronchitis, and sinus infections.
COPD development
Many patients with chronic untreated wheezing go on to develop chronic obstructive pulmonary disease (COPD). COPD includes emphysema and chronic bronchitis. The airflow limitation is progressive and irreversible. Smoking is a primary cause of COPD.
Heart problems
Wheezing makes the heart work harder to pump blood through the constricted airways. Over time, the increased strain on the heart can lead to pulmonary hypertension, arrhythmias, and eventual heart failure.
Emergency care and hospitalization
As asthma attacks become more severe and frequent, emergency care and hospitalization become increasingly common. Each year in the U.S., asthma accounts for nearly 2 million emergency department visits.
What are the long term effects of untreated wheezing?
Leaving wheezing untreated over many years can lead to some irreversible and permanent consequences:
Airway remodeling
Airway remodeling involves structural changes in the lungs. The walls thicken, mucus secretion increases, the muscles tighten, and the airways become twisted. This remodeling is irreversible and reduces lung capacity.
Permanent lung function impairment
With extensive airway remodeling, lung function decline can become permanent. Even with treatment, the lost function cannot be recovered.
Respiratory failure
In severe cases, untreated wheezing leads to respiratory failure. This is when the lungs can’t oxygenate the blood adequately or remove carbon dioxide effectively. Respiratory failure requires intensive care with oxygen therapy or mechanical ventilation.
Right heart failure
Pulmonary hypertension from chronic wheezing can ultimately cause the right side of the heart to fail. As the heart struggles to pump against high pressures, it enlarges and eventually loses pumping ability.
Death
Respiratory failure, right heart failure, or other complications can be fatal if wheezing is not treated. Globally, over 250,000 people die prematurely each year due to asthma. Early treatment and control of wheezing and asthma can prevent many deaths.
Treatment options for wheezing
Several effective treatment options are available for wheezing. The goals are to control symptoms, prevent complications, and improve quality of life. Common treatments include:
Bronchodilators
Bronchodilator inhalers relax the muscle bands around the airways. This relieves the constriction and opens the airways. Short-acting bronchodilators (albuterol, levalbuterol) provide quick relief of symptoms. Long-acting forms (salmeterol, formoterol) are used to control persistent wheezing.
Inhaled corticosteroids
These anti-inflammatory drugs reduce the swelling and mucus production in the airways. Inhaled corticosteroids such as beclomethasone, budesonide, and fluticasone are the most effective long-term control medications for persistent wheezing and asthma. They help prevent permanent changes to the lungs.
Leukotriene modifiers
Leukotriene modifiers block the action of leukotrienes, chemicals that cause airway constriction and inflammation. Drugs like montelukast (Singulair) and zafirlukast (Accolate) can help control wheezing, often used in combination with other medications.
Biologics
Newer biologics target specific parts of the immune system to reduce inflammation. They are used for patients with severe persistent asthma who don’t respond well to standard treatments. Omalizumab (Xolair) is an injectable drug used to treat allergic asthma.
Allergy treatment
For wheezing triggered by allergies, treatment includes avoiding exposure to allergens and undergoing immunotherapy (allergy shots) to desensitize the immune system. This can significantly improve symptoms and reduce medication needs.
Pulmonary rehabilitation
Supervised exercise training helps strengthen respiratory muscles and teaches techniques for clearing mucus. Improved fitness levels also benefit asthma control and quality of life.
Smoking cessation
Quitting smoking is essential to prevent worsening wheeze and lung function decline. Smoking cessation programs, nicotine replacement, and prescription medications help people quit.
Surgery
In rare cases, surgery to remove obstructing tissue in the airways helps improve wheezing symptoms. This includes procedures like bronchial thermoplasty.
Prevention of wheezing episodes
While wheezing often can’t be eliminated entirely, avoiding triggers can help prevent episodes:
- Avoid tobacco smoke and other respiratory irritants
- Use air filtration systems
- Get annual influenza and pneumonia vaccinations
- Treat reflux disease if present
- Use inhaled corticosteroids as prescribed
- Have an asthma action plan for handling attacks
- Learn techniques like pursed lip breathing and diaphragmatic breathing
Maintaining control of persistent wheezing requires actively working with your healthcare provider, tracking symptoms, adjusting medications, and avoiding triggers. But with the right treatment plan, most people can achieve good symptom control and prevent complications.
Conclusion
Wheezing is a common symptom of several respiratory conditions like asthma. When left untreated, it can lead to irreversible lung damage, COPD, heart problems, respiratory infections, reduced quality of life, and even death in severe cases. But various effective therapies are available to relieve wheezing, control underlying inflammation, and prevent permanent consequences. The key is partnering with your doctor to find the right treatment plan and diligently manage your condition long-term. With proper care, wheezing can be controlled and asthma attacks prevented despite ongoing susceptibility. Don’t ignore persistent wheezing – seek diagnosis and treatment early before severe lung changes occur. Consistent follow-up and active self-management are essential to prevent wheezing from significantly impacting your health and activities.
