Hey guys! Today we are going to talk about wheezing. First off, not all wheezing is asthma! Your child can wheeze for lots of different reasons and figuring out the reason can help in coming up with the best treatment plan. Today, we are going to review the anatomy of your child’s body, discuss the most common (and a few uncommon) reasons for wheezing and then how to fix it!
Let’s talk anatomy first. Think of your respiratory tract like an upside down tree with the trunk being the trachea, the large branches being the bronchi, the smaller branches and twigs being the bronchioles, and the leaves being the alveoli, or air sacks. Air enters into the system, goes down the pipes, and then oxygen and carbon dioxide are transported across the alveoli to the right places. So here’s the trick, any of these areas can be the cause of wheezing in an infant or child. Let’s talk about the common causes.
Asthma or reactive airways disease is caused by two main issues: twitchy airways and inflamed airways. Twitchy airways are when the branches or bronchi constrict in response to a trigger like smoke, paint fumes, harsh chemicals and/or infection. The inflamed airways can occur from the same triggers, but are basically just swelling of the walls of the bronchi. These two combined essentially make it harder to breath air out of the lungs and the narrower tubes cause the air move through faster, causing a whistling noise (aka wheezing). The treatment of asthma involves using a bronchodilator like albuterol to control the twitchy airways and anti-inflammatory medicines like steroids to control the swelling.
Bronchiolitis is a similar type illness, but it occurs in the smaller branches or bronchioles. The main causes of bronchiolitis are viral illnesses with the most common being RSV. The treatment of bronchiolitis is different for every child, but some respond to albuterol and anti-inflammatory medicines just like asthma. Also, bronchiolitis tends to occur in children less than twelve months, while asthma usually occurs after twelve months.
Croup is another cause of wheezing that has a distinctive “seal bark” cough and sometimes loud breathing noises on inspiration called stridor. My oldest child has had croup too many times to count, so I’ve seen this one first hand. Croup is caused by a virus that hangs out near the vocal cords and causes swelling and inflammation in the trunk or trachea. The treatment involves steroids for inflammation and sometimes special breathing treatments if the child has stridor.
Some other causes of wheezing can be from an anatomical obstruction like a foreign body or an abnormal growth in the trunk or trachea. These causes of wheezing are not fixed with albuterol or anti-inflammatory medicines and need to be evaluated by a specialist.
In the end, wheezing can have lots of causes, but there are a few things to always look for. First is the child’s color! Obviously, blue is bad, pink is good! Next, count how fast the child is breathing. Get a stopwatch and count how many breathes in a minute. Anything above forty might be abnormal. Then, look at the child’s chest. Are they sucking in breathes by using neck muscles or does it seem that their ribs are going in? This would be abnormal. Finally, note the child’s overall activity level. Can they play and talk comfortably or are they laying on the couch and speaking in short single word sentences? All of the facts combine to assess how serious the wheezing is and how to best treat it! Call your doctor immediately if you are worried and especially if you see any of the above signs or symptoms of respiratory distress.