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DIAGNOSIS/TREATMENT

■ Conduct a systematic diagnostic and therapeutic evaluation for the cause

of dyspnea.

■ Obtain a CXR at minimum. Obtain other studies (CT-PE, echocardio-

gram) based on clinical suspicion.

TREATMENT

Treat underlying condition.

Wheezing

A wheeze is a continuous musical sound lasting >100 msec. Wheezes can be

high or low pitched, consist of a single or multiple tones, and occur during

inspiration or expiration.

Wheezing is most likely to occur in obstructed airways (see Table 10.2) but

may occasionally be heard in a normal airway.

SYMPTOMS/EXAM

Look for symptoms/findings that suggest an underlying cause (eg, unilateral

wheezing in toddler suggesting foreign body aspiration).

DIFFERENTIAL

■ Rhonchi: Lower in pitch and longer in duration; a “snoring” quality

■ Crackles: Intermittent, explosive sounds of very brief duration; fine crackles

are higher pitched than coarse crackles

DIAGNOSIS

■ Conduct a systematic diagnostic and therapeutic evaluation for the cause

of wheezing.

■ If no prior history of wheezing, obtain a CXR at minimum. Obtain other

studies based on clinical suspicion.

TREATMENT

Treat underlying disorder.

THORACIC AND RESPIRATORY

DISORDERS

TABLE 10.1. Differential Diagnosis of Dyspnea

ACUTEDYSPNEA CHRONICDYSPNEA

(MINUTES TOHOURS)(DAYS TOYEARS)

Pulmonary disorders Pneumonia/bronchitis COPD

Pulmonary embolism Asthma

Pneumothorax Intertstitial lung disease

Bronchospasm (asthma, COPD) Pulmonary hypertension

Obstruction (anaphylaxis, aspiration)

Cardiovascular disorders Ischemia Cardiomyopathy

CHF

Cardiac tamponade

All that wheezes is not

asthma.