patient who is unable to do so and wheezes audibly in the attempt, is suffering from obstructive
airway disease. Another way of eliciting a wheeze is to press on the sternum while the patient
breathes out.
A wheeze is called polyphonic when it is composed of different sounds with different pitches all
starting and stopping at the same time, and monophonic when it is composed of single sounds,
each with its own pitch. A persistent, single, monophonic wheeze may indicate obstruction of a
bronchus by tumour.
The main conditions which may cause wheezing are acute and chronic bronchitis and asthma.
Acute Bronchitis
This is an inflammation of the trachea and bronchi caused by various pyogenic organisms such
as Strept. pneumoniae, H. influenzae or Staph. pyogenes.
The main clinical manifestations include a cough which is productive of mucoid, viscid sputum
in the beginning, then becoming more copious and purulent, breathlessness, wheezing, a feeling
of tightness of the chest, fever and leucocytosis.
Chronic Bronchitis
This condition is characterized by repeated attacks of cough during winter, gradually increasing
in frequency until the cough becomes almost constant. Other manifestations include wheezing,
tightness of the chest, tenacious, mucoid, purulent sputum and breathlessness.
Asthma
The pathology and clinical manifestations of this disease will be described in detail in the
chapter on allergic asthma (Chapter 5).