Is Your Chest Wheezing Caused by Asthma?

When you experience chest wheezing, you want to make sure you are correctly diagnosed. Several diseases, both common and not so common, can cause wheezing.

Woman who has asthma
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Two common diseases that may seem like asthma — because they can cause wheezing — are COPD and vocal chord dysfunction. They're discussed in detail below. Read more about other, less common causes of wheezing.

First, while there are many different types of asthma, all are linked to some or all of the classic symptoms of asthma:

Chronic Obstructive Pulmonary Disease (COPD)

Like asthma, COPD produces symptoms of shortness of breath, cough, wheezing, and chest tightness. However, there are a number of differences:

  • Age: While asthma can be diagnosed in older individuals and patients can have both asthma and COPD, COPD is more common among elderly smokers or former smokers. Asthma is more common in younger patients.
  • Symptom onset and variability: While asthma patients often feel well at baseline and develop symptoms acutely after exposure to triggers like dust mites, COPD patients do not have much day-to-day variability in their baseline symptoms and their symptoms develop gradually over years. Asthma patients will often return to normal and have significant periods when they are symptom-free. Asthma patients will often have allergic symptoms and evidence of allergic disease manifested by an increased eosinophil level or ​other allergic cell. In COPD you do not often see the allergic component.​Exercise symptoms: While exercise-induced asthma or exercise-induced bronchoconstriction symptoms usually start 5 minutes after the onset of exercise and peak within 20 minutes (whether or not you stop exercising) these symptoms can often be decreased by pre-treatment with a medication like Albuterol or more aggressive treatment of asthma.
    Exercise symptoms in COPD are generally related to the damage done to the lungs over time and the resulting development of decreased oxygenation in the blood with exercise. The symptoms are not generally decreased with pre-treatment with medication.
  • Pulmonary Function Testing: While both diseases are associated with decreased airflow in the lungs (FEV1) with spirometry, the obstruction associated with COPD does not reverse with a bronchodilator like Albuterol, as it does with asthma.
  • X-Ray testing: While both asthma and COPD may show hyper-expanded lungs on chest X-ray, COPD patients often have associated bullous changes that are not associated with asthma.
  • Causes. The exact cause of asthma is not known. There is definitely a genetic component with a patient more likely to have asthma if a parent or sibling has the disease. COPD, on the other hand, is almost always caused or significantly related to a history of smoking. Pollution, chemicals, and secondhand smoke are possible other causes, but this generally accounts for no more than 5% of COPD cases.
  • Treatments. Some of the treatments for COPD and asthma are the same. In both conditions, bronchodilators like albuterol relieve some of the acute symptoms of the disease. Inhaled steroids are also used as a chronic therapy in both conditions. There are differences, however. In asthma, one of the main treatments is to avoid a trigger like pollen or dust mites. With the exception of avoiding tobacco smoke, avoiding a specific trigger does not significantly decrease COPD symptoms. In COPD patients quitting smoking will provide a significant benefit. If COPD is severe than oxygen may be used as a chronic treatment, which is not commonly done in asthma.
  • Prognosis. While there is not a cure for either disease, COPD is generally progressive and gets worse over time. In COPD damaged lungs do not return to normal. In asthma, on the other hand, asthma can be controlled and some children to tend to grow out of it.

Vocal Chord Dysfunction

Vocal chord dysfunction, also referred to as "paradoxical laryngeal dysfunction" or "paradoxical vocal fold motion (PVFM)" commonly mimics asthma. Wheezing results from an unintentional closing of the vocal chords during breathing.

The Differences and Symptoms

Unlike asthma, patients often feel like wheezing is coming from their throat. Symptoms widely vary, as in asthma, with some patients experiencing mild symptoms while other patients require visits to the emergency room and even intubation. You may have vocal chord dysfunction if you have been aggressively treated for asthma without signs of abnormalities during pulmonary function testing.

Additionally, people with vocal chord dysfunction do not have typical pulmonary function tests. As would be expected, spirometry shows that the obstruction is outside of the lungs.

Who Gets Vocal Chord Dysfunction

Vocal chord dysfunction is more common among patients with anxiety and depression and has even been thought of as a conversion disorder. Vocal chord dysfunction is more common in adolescent girls and women.

Adolescent girls: Among teen girls, symptoms occur more commonly in athletes, almost always with increased intensity of exercise and during competition. In addition, these girls tend to be academic high achievers as well.

Older women: The other general group that seems to develop symptoms are middle-aged women with a history of psychiatric illness or major psychological trauma. Interestingly, increased numbers of people developing vocal chord dysfunction are employed in a health-related field.

Vocal chord dysfunction is primarily treated with speech therapy. While it is important to discontinue any unnecessary medications, this needs to be done gradually ad in consultation with your healthcare provider.

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  • Tilles, Stephen. Differential Diagnosis of Asthma. Medical Clinics of North America. Vol. 90 (2006):61-76.

By Pat Bass, MD
Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians.