Contributor: Travis Barlock, MD Educational Pearls:

• Wheezing is classically heard in asthma and COPD, but it can be the result of a wide range of processes that cause airflow limitation
  • Narrowed bronchioles lead to turbulent airflow → creates the wheezing
• Crackles (rales) suggest pulmonary edema which is often due to heart failure
• Approximately 35% of heart failure patients have bronchial edema, which can also produce wheezing
• COPD and heart failure can coexist in a patient, and both of these diseases can cause wheezing
  • It's vital to differentiate whether the wheezing is due to the patient's COPD or their heart failure because the treatment differs
• Diagnosing wheezing due to heart failure (cardiac asthma):
  • Symptoms: orthopnea, paroxysmal nocturnal dyspnea
  • Diagnostic tools: bedside ultrasound
  • Treatment: diuresis and BiPAP for respiratory support
• Not all wheezing is asthma
  • Consider heart failure in the differential and tailor treatment accordingly

References 1. Buckner K. Cardiac asthma. Immunol Allergy Clin North Am. 2013 Feb;33(1):35-44. doi: 10.1016/j.iac.2012.10.012. Epub 2012 Dec 23. PMID: 23337063.

2. Hollingsworth HM. Wheezing and stridor. Clin Chest Med. 1987 Jun;8(2):231-40. PMID: 3304813.

Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3

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