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Not All That Wheezes Is Asthma

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Kids Health Watch is brought to you by our friends and Magnolia Springs Pediatrics


Hey guys! Today we are going to talk about wheezing. First off, not all wheezing is asthma! Your child can wheeze for many dif­ferent reasons, and figuring out the cause can help develop the best treatment plan. Today, we will review the anatomy of your child’s body, discuss the most common (and a few uncommon) reasons for wheezing, and then discuss 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 the system, goes down the pipes, and oxygen and carbon dioxide are transported across the alveoli to the right places. So here’s the trick, any of these areas can cause wheezing in an infant or child. Let’s talk about the common causes.

First, asthma. Asthma, or reactive airway 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 just swelling of the walls of the bronchi. These two combined essen­tially make it harder to breathe air out of the lungs, and the narrower tubes cause the air to move through faster; therefore, you have 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 illness but occurs in smaller branches or bronchioles. The leading 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 with 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 firsthand. 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 due to 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 many causes, but there are a few things to always look for. First is the child’s color! Blue is bad. Pink is good! Next, count how fast the child is breathing. Get a stopwatch and count how many breaths they take in a minute. Anything above 40 might be abnormal. Then, look at the child’s chest. Are they sucking in breaths by using their 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 lying on the couch and speaking in short single-word sentences? All the facts combine to assess how severe 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. Good Luck!


Robert L. Rux, M.D. is a Board Certified Pediatrician at Magnolia Springs Pediatrics. Originally from Mobile, he attended medical school at The University of Alabama School of Medicine (UAB) and completed residency at The Children’s Hospital of Alabama (UAB).

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