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Wheezing is an abnormally high-pitched noise resulting from a partially obstructed airway. It is usually present during expiration when slight bronchoconstriction occurs. Bronchospasm, mucosal edema, loss of elastic support, and tortuosity of the airways are the usual causes. Asthma causes bronchospasm, which results in the wheezing associated with this condition. Obstruction by intraluminal material, such as aspirated foreign bodies or secretions, is another important cause of wheezing. A well-localized wheeze, unchanged by coughing, may indicate that a bronchus is partially obstructed by a foreign body or tumor. When a patient complains of wheezing, the examiner must determine the following:

''At what age did the wheezing begin?'' How often does it occur?''

Are there any precipitating factors, such as foods, odors, emotions, animals, and so forth?'' What usually stops the attack?'' Have the symptoms worsened over the years?'' Are there any associated symptoms?'' ''Is there a history of nasal polyps?''

Do you smoke?'' If so, What do you smoke? How much, and for how long?'' ''Is there a history of heart disease?''

An important axiom to remember is that asthma is associated with wheezing, but not all wheezing is asthma.

Do not equate wheezing with asthma. Although congestive heart failure is usually associated with abnormal breath sounds called crackles (discussed later in this chapter), sometimes there is such severe bronchospasm in heart failure that the main physical finding is a wheeze rather than a crackle.

A decrease in wheezing may result from either an opening of the airway or a progressive closing off of the air passage. A ''silent'' chest in a patient with an acute asthmatic attack is usually an ominous sign: It indicates worsening of the obstruction.

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