Less Common Causes of Chest Wheezing

Congestive heart failure (CHF) means the heart is unable to provide an adequate blood supply to the rest of the body. In addition to wheezing, patients have shortness of breath, difficulty breathing when lying flat, and swelling in the lower extremities.

Unlike wheezing in asthma patients, CHF patients will often have a large heart on chest X-ray. Additionally, a heart ultrasound will demonstrate a decreased ejection fraction or ability to adequately pump blood to the rest of the body.

This is a blood clot in the lungs. While a person with a PE may occasionally have wheezing symptoms, more common symptoms are a sudden onset of shortness of breath and chest pain. PE may be associated with risk factors such as:

• Use of birth control pills
• History of a previous blood clot
• Immobility associated with long plane or car trips

While both PE and asthma may be associated with a low level of oxygen in the blood as measured by pulse oximetry, a PE is associated with a blood clot in the blood vessels of the lung demonstrated by a spiral CT or VQ scan.

Patients with CF will usually have poor growth in childhood, cough, and shortness of breath in addition to wheezing.

While not frequently confused with asthma, CF can be diagnosed with a special test called the sweat chloride test.

Patients with bronchiectasis will often have episodes of recurrent pneumonia associated with cough and shortness of breath. If patients are treated with inhalers or corticosteroids, they will generally not respond.

Bronchiectasis may be diagnosed using a CT of the chest.

Wheezing from hypersensitivity pneumonitis results after chronic exposure to certain substances called antigens, such as moldy hay and bird droppings.

Unlike asthma, which causes an obstructive pattern on spirometry, hypersensitivity pneumonitis leads to a restrictive pattern. Wheezing generally goes away after removal of the offending antigen.

While GERD can be a cause of worsening asthma, GERD can also lead to less common causes of wheezing from recurrent pneumonia or scarring of the lungs.

Unlike asthma, wheezing from this condition usually goes away after treatment of the underlying condition.