Causes of Asthma

Causes of Asthma: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Asthma.

Stridor & Wheezing: Differential Diagnosis
(In a Page: Signs and Symptoms)

Stridor (inspiratory)

• Croup (laryngotracheobronchitis)
  –Viral infection with tracheal narrowing due to airway edema
  –“Bark-like” cough, hoarseness

• Epiglottitis
  –Airway emergency most commonly due to Haemophilus influenzae or group A streptococcus infection
  –Abrupt onset of high fevers, sore throat, hoarseness, dysphagia, respiratory distress

• Foreign body lodged in the upper airway
• Allergic reaction/anaphylaxis
  –May have urticaria and angioedema (subcutaneous or mucosal swelling, often of the lips)
• Trauma
• Postendotracheal intubation
• Psychogenic (e.g., paroxysmal vocal cord dyskinesia)
  Stridor (expiratory)
• COPD (expiratory vocalization to prolong time to airway closure and avoid air trapping)
• Cardiac failure (expiratory vocalization to prolong increased intrathoracic pressure and unload left ventricle)

• Asthma
  –Triad of chronic cough, dyspnea, wheezing
  –Wheezing may be absent in cases of severe obstruction (insufficient air movement)

• Pulmonary edema
  –Leakage of fluid into the interstitium and alveoli due to elevated capillary pressure (cardiogenic) or abnormal capillary permeability (noncardiogenic)

• Aspirated foreign body
  –Abrupt onset of unilateral wheezing or stridor (if lodged in the upper airway), cough, and decreased breath sounds

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Stridor: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Nasal cavity and nasopharynx

• Congenital
  –Piriform aperture stenosis
  –Choanal atresia
  –Lacrimal duct cyst
  –Craniofacial anomaly
  –Nasopharyngeal mass (teratoma)
• Inflammatory/infectious
  –Rhinosinusitis
  –Adenoid hypertrophy

Oral cavity, oropharynx, and hypopharynx
• Congenital
  –Macroglossia
  –Glossoptosis
  –Vallecular cyst
• Inflammatory/infectious
  –Tonsillar hypertrophy
• Tumors
  –Lingual thyroid
  –Dermoid
  –Lymphovascular malformation
• Foreign body

• Congenital
  –Laryngomalacia (#1 cause in infants); usual onset is in the first 2 weeks of life, typically positional; most resolve spontaneously by age 1
  –Saccular cyst
  –Webs
  –Clefts
  –Vocal cord paralysis

• Inflammatory/infectious
  –Epiglottitis
  –Laryngotracheitis (croup)
  –Gastroesophageal reflux
• Tumors
  –Papillomas
  –Hemangiomas
• Trauma
  –Subglottic stenosis
  –Foreign bodies
  –Laryngeal fracture
  –Caustic ingestion
  Tracheobronchial
• Congenital
  –Tracheomalacia
  –Vascular rings
  –Tracheoesophageal fistula
• Inflammatory

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Wheezing: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Lower airway (expiratory, polyphonic)

• Extraluminal compression of airways
  –Parenchymal: Pneumonia, pulmonary edema, bronchogenic cyst
  –Vascular: Ring, sling, “cardiac wheeze”
  –Lymphatics: Enlarged lymph nodes (TB, sarcoidosis, malignancy)
  –Structural: CLE, scoliosis, or chest wall deformity with airway “kinking”
• Transluminal change in airway
  –Asthma: Inflammation, edema, hyperemia, mucus gland hypertrophy and proliferation, smooth muscle bronchospasm
  –Bronchiectasis/bronchitis
  –Cystic fibrosis
  –Ciliary disease: Primary ciliary dyskinesia, dysfunction due to ETS or hyperoxia
  –Anatomic: Hemangioma, polyps, TEF, bronchial atresia, BALT, bronchiolitis obliterans, tracheobronchomalacia
  –Immunologic disorders (e.g., IgA deficiency)

• Intraluminal change in airway
  –Mucus (increased production or decreased clearance), pus (infected sputum), blood
  –Foreign body
  –Aspirated food or stomach contents secondary to gastroesophageal reflux
  Upper airway (usually inspiratory and monophonic)

• Nasal (congestion, choanal atresia, FB)
• Oropharyngeal (tonsils, adenoids, macroglossia, foreign body, decreased tone, retropharyngeal abscess)
• Laryngeal (laryngomalacia, vocal cord dysfunction or paralysis, laryngeal web or polyp, subglottic stenosis)

Central nervous system
• Structural disease (e.g., Arnold-Chiari malformation leading to vocal cord paralysis)
• Functional (e.g., vocal cord dysfunction, chronic aspiration)

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Stridor: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Airway trauma

Local trauma to the upper airway commonly causes acute obstruction, resulting in the sudden onset of stridor. Accompanying this sign are dysphonia, dysphagia, hemoptysis, cyanosis, accessory muscle use, intercostal retractions, nasal flaring, tachypnea, progressive dyspnea, and shallow respirations. Palpation may reveal subcutaneous crepitation in the neck or upper chest.

Anaphylaxis

With a severe allergic reaction, upper airway edema and laryngospasm cause stridor and other signs and symptoms of respiratory distress: nasal flaring, wheezing, accessory muscle use, intercostal retractions, and dyspnea. The patient may also develop nasal congestion and profuse, watery rhinorrhea. Typically, these respiratory effects are preceded by a feeling of impending doom or fear, weakness, diaphoresis, sneezing, nasal pruritus, urticaria, erythema, and angioedema. Common associated findings include chest or throat tightness, dysphagia and, possibly, signs of shock, such as hypotension, tachycardia, and cool, clammy skin.

Anthrax (inhalation)

Initial signs and symptoms are flulike and include a fever, chills, weakness, a cough, and chest pain. The disease generally occurs in two stages with a period of recovery after the initial symptoms. The second stage develops abruptly with rapid deterioration marked by stridor, a fever, dyspnea, and hypotension generally leading to death within 24 hours. Radiologic findings include mediastinitis and symmetric mediastinal widening.

Aspiration of a foreign body

Sudden stridor is characteristic in foreign body aspiration, a life-threatening situation. Related findings include an abrupt onset of dry, paroxysmal coughing; gagging or choking; hoarseness; tachycardia; wheezing; dyspnea; tachypnea; intercostal muscle retractions; diminished breath sounds; cyanosis; and shallow respirations. The patient typically appears anxious and distressed.

Hypocalcemia

With hypocalcemia, laryngospasm can cause stridor. Other findings include paresthesia, carpopedal spasm, and positive Chvostek’s and Trousseau’s signs.

Inhalation injury

Within 48 hours after inhalation of smoke or noxious fumes, the patient may develop laryngeal edema and bronchospasms, resulting in stridor. Associated signs and symptoms include singed nasal hairs, orofacial burns, coughing, hoarseness, sooty sputum, crackles, rhonchi, wheezes, and other signs and symptoms of respiratory distress, such as dyspnea, accessory muscle use, intercostal retractions, and nasal flaring.

Mediastinal tumor

Commonly producing no symptoms at first, a mediastinal tumor may eventually compress the trachea and bronchi, resulting in stridor. Its other effects include hoarseness, a brassy cough, a tracheal shift or tug, dilated neck veins, swelling of the face and neck, stertorous respirations, and suprasternal retractions on inspiration. The patient may also report dyspnea, dysphagia, and pain in the chest, shoulder, or arm.

Retrosternal thyroid

Retrosternal thyroid is an anatomic abnormality that causes stridor, dysphagia, a cough, hoarseness, and tracheal deviation. It can also cause signs of thyrotoxicosis.

Other causes

Diagnostic tests

Bronchoscopy or laryngoscopy may precipitate laryngospasm and stridor.

Treatments

After prolonged intubation, the patient may exhibit laryngeal edema and stridor when the tube is removed. Aerosol therapy with epinephrine may reduce stridor. Reintubation may be necessary in some cases. Neck surgery, such as thyroidectomy, may cause laryngeal paralysis and stridor.

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Wheezing [Sibilant rhonchi]: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Anaphylaxis

Anaphylaxis is an allergic reaction that can cause tracheal edema or bronchospasm, resulting in severe wheezing and stridor. Initial signs and symptoms include fright, weakness, sneezing, dyspnea, nasal pruritus, urticaria, erythema, and angioedema. Respiratory distress occurs with nasal flaring, accessory muscle use, and intercostal retractions. Other findings include nasal edema and congestion; profuse, watery rhinorrhea; chest or throat tightness; and dysphagia. Cardiac effects include arrhythmias and hypotension.

Aspiration of a foreign body

Partial obstruction by a foreign body produces sudden onset of wheezing and possibly stridor; a dry, paroxysmal cough; gagging; and hoarseness. Other findings include tachycardia, dyspnea, decreased breath sounds and, possibly, cyanosis. A retained foreign body may cause inflammation leading to fever, pain, and swelling.

Aspiration pneumonitis

With aspiration pneumonitis, wheezing may accompany tachypnea, marked dyspnea, cyanosis, tachycardia, fever, productive (eventually purulent) cough, and pink, frothy sputum.

Asthma

Wheezing is an initial and cardinal sign of asthma. It’s heard at the mouth during expiration. An initially dry cough later becomes productive with thick mucus. Other findings include apprehension, prolonged expiration, intercostal and supraclavicular retractions, rhonchi, accessory muscle use, nasal flaring, and tachypnea. Asthma also produces tachycardia, diaphoresis, and flushing or cyanosis.

Bronchial adenoma

Bronchial adenoma, an insidious disorder, produces unilateral, possibly severe wheezing. Common features are chronic cough and recurring hemoptysis. Symptoms of airway obstruction may occur later.

Bronchiectasis

Excessive mucus commonly causes intermittent and localized or diffuse wheezing. A copious, foul-smelling, mucopurulent cough is classic. It’s accompanied by hemoptysis, rhonchi, and coarse crackles. Weight loss, fatigue, weakness, exertional dyspnea, fever, malaise, halitosis, and late-stage clubbing may also occur.

Bronchitis (chronic)

Bronchitis causes wheezing that varies in severity, location, and intensity. Associated findings include prolonged expiration, coarse crackles, scattered rhonchi, and a hacking cough that later becomes productive. Other effects include dyspnea, accessory muscle use, barrel chest, tachypnea, clubbing, edema, weight gain, and cyanosis.

Bronchogenic carcinoma

Obstruction may cause localized wheezing. Typical findings include a productive cough, dyspnea, hemoptysis (initially blood-tinged sputum, possibly leading to massive hemorrhage), anorexia, and weight loss. Upper extremity edema and chest pain may also occur.

Emphysema

Mild to moderate wheezing may occur with emphysema, a form of chronic obstructive pulmonary disease. Related findings include dyspnea, malaise, tachypnea, diminished breath sounds, peripheral cyanosis, pursed-lip breathing, anorexia, and malaise. Accessory muscle use, barrel chest, a chronic productive cough, and clubbing may also occur.

Pulmonary coccidioidomycosis

Pulmonary coccidioidomycosis may cause wheezing and rhonchi along with cough, fever, chills, pleuritic chest pain, headache, weakness, malaise, anorexia, and macular rash.

Pulmonary edema

Wheezing may occur with pulmonary edema, a life-threatening disorder. Other signs and symptoms include coughing, exertional and paroxysmal nocturnal dyspnea and, later, orthopnea. Examination reveals tachycardia, tachypnea, dependent crackles, and a diastolic gallop. Severe pulmonary edema produces rapid, labored respirations; diffuse crackles; a productive cough with frothy, bloody sputum; arrhythmias; cold, clammy, cyanotic skin; hypotension; and thready pulse.

Tracheobronchitis

Auscultation may detect wheezing, rhonchi, and crackles. The patient also has a cough, slight fever, sudden chills, muscle and back pain, and substernal tightness.

Wegener’s granulomatosis

Wegener’s granulomatosis may cause mild to moderate wheezing if it compresses major airways. Other findings include a cough (possibly bloody), dyspnea, pleuritic chest pain, hemorrhagic skin lesions, and progressive renal failure. Epistaxis and severe sinusitis are common.

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Asthma: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Asthma that results from sensitivity to specific external allergens is known as extrinsic. In cases in which the allergen isn’t obvious, asthma is referred to as intrinsic. Allergens that cause extrinsic asthma include pollen, animal dander, house dust or mold, kapok or feather pillows, food additives containing sulfites, and any other sensitizing substance. Extrinsic (atopic) asthma usually begins in childhood and is accompanied by other manifestations of atopy (type I, immunoglobulin [Ig] E-mediated allergy), such as eczema and allergic rhinitis. In intrinsic (nonatopic) asthma, no extrinsic allergen can be identified. Most cases are preceded by a severe respiratory infection. Irritants, emotional stress, fatigue, exposure to noxious fumes as well as changes in endocrine, temperature, and humidity may aggravate intrinsic asthma attacks. In many asthmatics, intrinsic and extrinsic asthma coexist.

Several drugs and chemicals may provoke an asthma attack without using the IgE pathway. Apparently, they trigger release of mast-cell mediators by way of prostaglandin inhibition. Examples of these substances include aspirin, various nonsteroidal anti-inflammatory drugs (such as indomethacin and mefenamic acid), and tartrazine, a yellow food dye. Exercise may also provoke an asthma attack. In exercise-induced asthma, bronchospasm may follow heat and moisture loss in the upper airways.

The allergic response has two phases. When the patient inhales an allergenic substance, sensitized IgE antibodies trigger mast-cell degranulation in the lung interstitium, releasing histamine, cytokines, prostaglandins, thromboxanes, leukotrienes, and eosinophil chemotaxic factors. Histamine then attaches to receptor sites in the larger bronchi, causing irritation, inflammation, and edema. In the late phase, inflammatory cells flow in. The influx of eosinophils provides additional inflammatory mediators and contributes to local injury.

Although this common condition can strike at any age, half of all cases first occur in children younger than age 10; in this age-group, asthma affects twice as many males as females. Nearly 1 in 13 children have asthma, which is increasing worldwide. Emergency department visits, hospitalizations, and mortality from asthma have been increasing for more than 20 years, especially among children and blacks.

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Stridor: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Airway trauma

Local trauma to the upper airway commonly causes acute obstruction, resulting in the sudden onset of stridor. Accompanying this sign are dysphonia, dysphagia, hemoptysis, cyanosis, accessory muscle use, intercostal retractions, nasal flaring, tachypnea, progressive dyspnea, and shallow respirations. Palpation may reveal subcutaneous crepitation in the neck or upper chest.

Anaphylaxis

With a severe allergic reaction, upper airway edema and laryngospasm cause stridor and other signs and symptoms of respiratory distress: nasal flaring, wheezing, accessory muscle use, intercostal retractions, and dyspnea. The patient may also develop nasal congestion and profuse, watery rhinorrhea. Typically, these respiratory effects are preceded by a feeling of impending doom or fear, weakness, diaphoresis, sneezing, nasal pruritus, urticaria, erythema, and angioedema. Common associated findings include chest or throat tightness, dysphagia and, possibly, signs of shock, such as hypotension, tachycardia, and cool, clammy skin.

Anthrax, inhalation

Initial signs and symptoms are flulike and include fever, chills, weakness, cough, and chest pain. The disease generally occurs in two stages with a period of recovery after the initial symptoms. The second stage develops abruptly with rapid deterioration marked by stridor, fever, dyspnea, and hypotension generally leading to death within 24 hours. Radiologic findings include mediastinitis and symmetric mediastinal widening.

Aspiration of a foreign body

Sudden stridor is characteristic in this life-threatening situation. Related findings include abrupt onset of dry, paroxysmal coughing, gagging or choking, hoarseness, tachycardia, wheezing, dyspnea, tachypnea, intercostal muscle retractions, diminished breath sounds, cyanosis, and shallow respirations. The patient typically appears anxious and distressed.

Epiglottiditis

With this inflammatory condition, stridor is caused by an erythematous, edematous epiglottis that obstructs the upper airway. Stridor occurs along with fever, sore throat, and a croupy cough.

Hypocalcemia

With this disorder, laryngospasm can cause stridor. Other findings include paresthesia, carpopedal spasm, and positive Chvostek’s and Trousseau’s signs.

Inhalation injury

Within 48 hours after inhalation of smoke or noxious fumes, the patient may develop laryngeal edema and bronchospasms, resulting in stridor. Associated signs and symptoms include singed nasal hairs, orofacial burns, coughing, hoarseness, sooty sputum, crackles, rhonchi, wheezes, and other signs and symptoms of respiratory distress, such as dyspnea, accessory muscle use, intercostal retractions, and nasal flaring.

Laryngeal tumor

Stridor is a late sign and may be accompanied by dysphagia, dyspnea, enlarged cervical nodes, and pain that radiates to the ear. Typically, stridor is preceded by hoarseness, minor throat pain, and a mild, dry cough.

Laryngitis (acute)

This disorder may cause severe laryngeal edema, resulting in stridor and dyspnea. Its chief sign, however, is mild to severe hoarseness, perhaps with transient voice loss. Other findings include sore throat, dysphagia, dry cough, malaise, and fever.

Mediastinal tumor

Commonly producing no symptoms at first, this type of tumor may eventually compress the trachea and bronchi, resulting in stridor. Its other effects include hoarseness, brassy cough, tracheal shift or tug, dilated neck veins, swelling of the face and neck, stertorous respirations, and suprasternal retractions on inspiration. The patient may also report dyspnea, dysphagia, and pain in the chest, shoulder, or arm.

Retrosternal thyroid

This anatomic abnormality causes stridor, dysphagia, cough, hoarseness, and tracheal deviation. It can also cause signs of thyrotoxicosis.

Thoracic aortic aneurysm

If this aneurysm compresses the trachea, it may cause stridor accompanied by dyspnea, wheezing, and a brassy cough. Other findings include hoarseness or complete voice loss, dysphagia, jugular vein distention, prominent chest veins, tracheal tug, paresthesia or neuralgia, and edema of the face, neck, and arms. The patient may also complain of substernal, lower back, abdominal, or shoulder pain.

Other causes

Diagnostic tests

Bronchoscopy or laryngoscopy may precipitate laryngospasm and stridor.

Treatments

After prolonged intubation, the patient may exhibit laryngeal edema and stridor when the tube is removed. Aerosol therapy with epinephrine may reduce stridor. Reintubation may be necessary in some cases. Neck surgery, such as thyroidectomy, may cause laryngeal paralysis and stridor.

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Wheezing [Sibilant rhonchi]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Anaphylaxis

This allergic reaction can cause tracheal edema or bronchospasm, resulting in severe wheezing and stridor. Initial signs and symptoms include apprehension, weakness, sneezing, dyspnea, nasal pruritus, urticaria, erythema, and angioedema. Respiratory distress occurs with nasal flaring, accessory muscle use, and intercostal retractions. Other findings include nasal edema and congestion, profuse watery rhinorrhea, chest or throat tightness, and dysphagia. Cardiac effects include arrhythmias and hypotension.

Aspiration of a foreign body

Partial obstruction by a foreign body produces sudden onset of wheezing and possibly stridor; a dry, paroxysmal cough; gagging; and hoarseness. Other findings include tachycardia, dyspnea, decreased breath sounds, and possibly cyanosis. A retained foreign body may cause inflammation leading to fever, pain, and swelling.

Aspiration pneumonitis

In this disorder, wheezing may accompany tachypnea, marked dyspnea, cyanosis, tachycardia, fever, a productive (eventually purulent) cough, and frothy pink sputum.

Asthma

Wheezing is an initial and cardinal sign of asthma. It’s heard at the mouth during expiration. An initially dry cough later becomes productive with thick mucus. Other findings include apprehension, prolonged expiration, intercostal and supraclavicular retractions, rhonchi, accessory muscle use, nasal flaring, and tachypnea. Asthma also produces tachycardia, diaphoresis, and flushing or cyanosis.

Blast lung injury

Wheezing is a common symptom of this condition, which is characterized by hypoxia and respiratory difficulty. The forceful blast wave that follows an explosive detonation can cause serious lung injury, including hemorrhage, contusion, edema, and tearing. In addition to wheezing, patients may exhibit chest pain, dyspnea, cyanosis, and hemoptysis. The diagnosis is confirmed by chest X-rays that show a classic “butterfly” pattern.

Bronchial adenoma

This insidious disorder produces unilateral, possibly severe wheezing. Common features are a chronic cough and recurring hemoptysis. Symptoms of airway obstruction may occur later.

Bronchiectasis

In this disorder, excessive mucus commonly causes intermittent and localized or diffuse wheezing. Characteristic findings include a chronic cough that produces copious amounts of foul-smelling, mucopurulent sputum; hemoptysis; rhonchi; and coarse crackles. Weight loss, fatigue, weakness, exertional dyspnea, fever, malaise, halitosis, and late-stage clubbing may also occur.

Bronchitis (chronic)

This disorder causes wheezing that varies in severity, location, and intensity. Associated findings include prolonged expiration, coarse crackles, scattered rhonchi, and a hacking cough that later becomes productive. Other effects include dyspnea, accessory muscle use, barrel chest, tachypnea, clubbing, edema, weight gain, and cyanosis.

Bronchogenic carcinoma

Obstruction may cause localized wheezing. Typical findings include a productive cough, dyspnea, hemoptysis (initially blood-tinged sputum, possibly leading to massive hemorrhage), anorexia, and weight loss. Upper extremity edema and chest pain may also occur.

Chemical pneumonitis (acute)

Mucosal injury causes increased secretions and edema, leading to wheezing, dyspnea, orthopnea, crackles, malaise, fever, and a productive cough with purulent sputum. The patient may also have signs of conjunctivitis, pharyngitis, laryngitis, and rhinitis.

Emphysema

Mild to moderate wheezing may occur in this form of chronic obstructive pulmonary disease. Related findings include dyspnea, tachypnea, diminished breath sounds, peripheral cyanosis, pursed-lip breathing, anorexia, and malaise. Accessory muscle use, barrel chest, a chronic productive cough, and clubbing may also occur.

Inhalation injury

Early findings include hoarseness and coughing, singed nasal hairs, orofacial burns, and soot-stained sputum. Later effects may include wheezing, crackles, rhonchi, and respiratory distress.

Pneumothorax (tension)

This life-threatening disorder causes respiratory distress with possible wheezing, dyspnea, tachycardia, tachypnea, and sudden, severe, sharp chest pain (often unilateral). Other findings include a dry cough, cyanosis, accessory muscle use, asymmetrical chest wall movement, anxiety, and restlessness. Examination reveals hyperresonance or tympany and diminished or absent breath sounds on the affected side, subcutaneous crepitation, decreased vocal fremitus, and tracheal deviation.

Pulmonary coccidioidomycosis

This disorder may cause wheezing and rhonchi along with cough, fever, chills, pleuritic chest pain, headache, weakness, malaise, anorexia, and macular rash.

Pulmonary edema

This life-threatening disorder may cause wheezing, coughing, exertional and paroxysmal nocturnal dyspnea and, later, orthopnea. Examination reveals tachycardia, tachypnea, dependent crackles, and a diastolic gallop. Severe pulmonary edema produces rapid, labored respirations; diffuse crackles; a productive cough with frothy, bloody sputum; arrhythmias; cold, clammy, cyanotic skin; hypotension; and a thready pulse.

Pulmonary embolus

Diffuse, mild wheezing rarely occurs in this disorder, which is characterized by dyspnea, chest pain, and cyanosis.

Pulmonary tuberculosis

In late stages, fibrosis causes wheezing. Common findings include a mild to severe productive cough with pleuritic chest pain and fine crackles, night sweats, anorexia, weight loss, fever, malaise, dyspnea, and fatigue. Examination reveals dullness on percussion, increased tactile fremitus, and amphoric breath sounds.

Respiratory syncytial virus (RSV)

Infected individuals commonly develop wheezing and other symptoms within 4 to 6 days of exposure to this virus. Healthy adults and children older than age 3 usually have mild cases of RSV and experience wheezing along with other common cold-like symptoms of runny nose, cough, and low-grade fever. In children ages 3 and younger, high-pitched expiratory wheezing can accompany a severe cough, rapid breathing, and high-grade fever. RSV is the primary cause of lower respiratory tract infection in infants, who may develop pneumonia or bronchiolitis. Infection-control practices help prevent the spread of this virus, which can be inactivated by disinfectants or soap and water. A vaccine is being researched for this common condition that affects most children by age 2.  

Thyroid goiter

This disorder may produce no symptoms, or it may cause wheezing, dysphagia, and respiratory difficulty related to a compressed airway.

Tracheobronchitis

Auscultation may detect wheezing, rhonchi, and crackles. The patient also has a cough, a slight fever, sudden chills, muscle and back pain, and substernal tightness.

Wegener’s granulomatosis

This disorder may cause mild to moderate wheezing if it compresses major airways. Other findings include a cough (possibly bloody), dyspnea, pleuritic chest pain, hemorrhagic skin lesions, and progressive renal failure. Epistaxis and severe sinusitis are common.

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Wheezing: Differential Overview
(Field Guide to Bedside Diagnosis)

Wheezing

❑ Asthma

❑ Reactive airways disease

❑ Pulmonary edema

❑ Pulmonary embolism

❑ Emphysema

❑ Gastroesophageal reflux

❑ Drug/toxin reaction

❑ Vocal cord dysfunction

❑ Foreign body aspiration

❑ Mediastinal mass

❑ Carcinoid syndrome

Stridor

❑ Mucus plug

❑ Laryngeal trauma

❑ Angioedema

❑ Acute epiglottitis

❑ Retropharyngeal abscess

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Asthma: Causes
(Handbook of Diseases)

AGE ALERT: Although this common condition can strike at any age, half of all cases first occur in children younger than age 10; in this age-group, asthma affects twice as many boys as girls. The sex ratio equalizes by age 30.

Extrinsic and intrinsic asthma

Asthma that results from sensitivity to specific external allergens is referred to as extrinsic (atopic). In those cases where the allergen isn’t obvious, asthma is referred to as intrinsic (nonatopic). Allergens that cause extrinsic asthma include pollen, animal dander, house dust or mold, kapok or feather pillows, food additives containing sulfites, and any other sensitizing substance.

Extrinsic asthma usually begins in childhood and is accompanied by other manifestations of atopy (type I, immunoglobulin [Ig] E–mediated allergy), such as eczema and allergic rhinitis.

With intrinsic asthma, no extrinsic allergen can be identified. Most cases are preceded by a severe respiratory tract infection. Irritants, emotional stress, fatigue, exposure to noxious fumes, and endocrine, temperature, and humidity changes may aggravate intrinsic asthma attacks.

For many asthmatics, intrinsic and extrinsic asthma coexist.

Other asthma triggers

Several drugs and chemicals may provoke an asthma attack without using the IgE pathway. Apparently, they trigger release of mast cell mediators via prostaglandin inhibition. Examples of these substances include aspirin, various nonsteroidal anti-inflammatory drugs (such as indomethacin and mefenamic acid), and tartrazine, a yellow food dye.

Exercise may also provoke an asthma attack. With exercise-induced asthma, bronchospasm may follow heat and moisture loss in the upper airways.

Two-phase allergic response

When the patient inhales an allergenic substance, sensitized IgE antibodies trigger mast cell degranulation in the lung interstitium, releasing histamine, cytokines, prostaglandins, thromboxanes, leukotrienes, and eosinophil chemotaxic factors. Histamine then attaches to receptor sites in the larger bronchi, causing irritation, inflammation, and edema. In the late phase, inflammatory cells flow in. The influx of eosinophils provides additional inflammatory mediators and contributes to local injury.

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Stridor: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Airway trauma

Local trauma to the upper airway commonly causes acute obstruction, resulting in the sudden onset of stridor. Accompanying this sign are dysphonia, dysphagia, hemoptysis, cyanosis, accessory muscle use, intercostal retractions, nasal flaring, tachypnea, progressive dyspnea, and shallow respirations. Palpation may reveal subcutaneous crepitation in the neck or upper chest.

Anaphylaxis

With a severe allergic reaction, upper airway edema and laryngospasm cause stridor and other signs and symptoms of respiratory distress — nasal flaring, wheezing, accessory muscle use, intercostal retractions, and dyspnea. The patient may also develop nasal congestion and profuse, watery rhinorrhea. Typically, these respiratory effects are preceded by a feeling of impending doom or fear, weakness, diaphoresis, sneezing, nasal pruritus, urticaria, erythema, and angioedema. Common associated findings include chest or throat tightness, dysphagia and, possibly, signs of shock, such as hypotension, tachycardia, and cool, clammy skin.

Anthrax (inhalation)

Initial signs and symptoms of inhalation anthrax are flulike and include fever, chills, weakness, cough, and chest pain. The disease generally occurs in two stages with a period of recovery after the initial symptoms. The second stage develops abruptly with rapid deterioration marked by stridor, fever, dyspnea, and hypotension generally leading to death within 24 hours. Radiologic findings include mediastinitis and symmetric mediastinal widening.

Aspiration of a foreign body

Sudden stridor is characteristic in this life-threatening situation. Related findings include an abrupt onset of dry, paroxysmal coughing, gagging or choking, hoarseness, tachycardia, wheezing, dyspnea, tachypnea, intercostal muscle retractions, diminished breath sounds, cyanosis, and shallow respirations. The patient typically appears anxious and distressed.

Epiglottiditis

With epiglottiditis, an inflammatory condition, stridor is caused by an erythematous, edematous epiglottis that obstructs the upper airway. Stridor occurs along with fever, sore throat, and a croupy cough.

Hypocalcemia

With hypocalcemia, laryngospasm can cause stridor. Other findings include paresthesia, carpopedal spasm, and positive Chvostek’s and Trousseau’s signs.

Inhalation injury

Within 48 hours after inhalation of smoke or noxious fumes, the patient may develop laryngeal edema and bronchospasms, resulting in stridor. Associated signs and symptoms include singed nasal hairs, orofacial burns, coughing, hoarseness, sooty sputum, crackles, rhonchi, wheezes, and other signs and symptoms of respiratory distress, such as dyspnea, accessory muscle use, intercostal retractions, and nasal flaring.

Laryngeal tumor

Stridor is a late sign and may be accompanied by dysphagia, dyspnea, enlarged cervical nodes, and pain that radiates to the ear. Typically, stridor is preceded by hoarseness, minor throat pain, and a mild, dry cough.

Laryngitis (acute)

Acute laryngitis may cause severe laryngeal edema, resulting in stridor and dyspnea. Its chief sign, however, is mild to severe hoarseness, perhaps with transient voice loss. Other findings include sore throat, dysphagia, dry cough, malaise, and fever.

Mediastinal tumor

Commonly producing no symptoms at first, this type of tumor may eventually compress the trachea and bronchi, resulting in stridor. Its other effects include hoarseness, brassy cough, tracheal shift or tug, jugular vein distention, face and neck swelling, stertorous respirations, and suprasternal retractions on inspiration. The patient may also report dyspnea, dysphagia, and pain in the chest, shoulder, or arm.

Retrosternal thyroid

An anatomic abnormality, retrosternal thyroid causes stridor, dysphagia, cough, hoarseness, and tracheal deviation. It can also cause signs of thyrotoxicosis.

Thoracic aortic aneurysm

If this aneurysm compresses the trachea, it may cause stridor accompanied by dyspnea, wheezing, and a brassy cough. Other findings include hoarseness or complete voice loss, dysphagia, jugular vein distention, prominent chest veins, tracheal tug, paresthesia or neuralgia, and edema of the face, neck, and arms. The patient may also complain of substernal, lower back, abdominal, or shoulder pain.

Other causes

Diagnostic tests

Bronchoscopy or laryngoscopy may precipitate laryngospasm and stridor.

Medical treatments

After prolonged intubation, the patient may exhibit laryngeal edema and stridor when the tube is removed. Aerosol therapy with epinephrine may reduce stridor. Reintubation may be necessary in some cases. Neck surgery, such as thyroidectomy, may cause laryngeal paralysis and stridor.

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Wheezing: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Anaphylaxis

An allergic reaction, anaphylaxis can cause tracheal edema or bronchospasm, resulting in severe wheezing and stridor. Initial signs and symptoms include fright, weakness, sneezing, dyspnea, nasal pruritus, urticaria, erythema, and angioedema. Respiratory distress occurs with nasal flaring, accessory muscle use, and intercostal retractions. Other findings include nasal edema and congestion with profuse, watery rhinorrhea as well as chest or throat tightness and dysphagia. Cardiac effects include arrhythmias and hypotension.

Aspiration of a foreign body

Partial obstruction by a foreign body produces the sudden onset of wheezing and possibly stridor; a dry, paroxysmal cough; gagging; and hoarseness. Other findings include tachycardia, dyspnea, decreased breath sounds and, possibly, cyanosis. A retained foreign body may cause inflammation leading to fever, pain, and swelling.

Aspiration pneumonitis

With aspiration pneumonitis, wheezing may accompany tachypnea, marked dyspnea, cyanosis, tachycardia, fever, a productive (eventually purulent) cough, and pink, frothy sputum.

Asthma

Wheezing is an initial and cardinal sign of asthma. It’s heard at the mouth during expiration. An initially dry cough later becomes productive with thick mucus. Other findings include apprehension, prolonged expiration, intercostal and supraclavicular retractions, rhonchi, accessory muscle use, nasal flaring, and tachypnea. Asthma also produces tachycardia, diaphoresis, and flushing or cyanosis.

Bronchial adenoma

An insidious disorder, bronchial adenoma produces unilateral, possibly severe wheezing. Common features are chronic cough and recurring hemoptysis. Symptoms of airway obstruction may occur later.

Bronchiectasis

Excessive mucus commonly causes intermittent and localized or diffuse wheezing. A copious, foul-smelling, mucopurulent cough is classic. It’s accompanied by hemoptysis, rhonchi, and coarse crackles. Weight loss, fatigue, weakness, exertional dyspnea, fever, malaise, halitosis, and late-stage clubbing may also occur.

Bronchitis (chronic)

Chronic bronchitis causes wheezing that varies in severity, location, and intensity. Associated findings include prolonged expiration, coarse crackles, scattered rhonchi, and a hacking cough that later becomes productive. Other effects include dyspnea, accessory muscle use, barrel chest, tachypnea, clubbing, edema, weight gain, and cyanosis.

Bronchogenic carcinoma

Obstruction may cause localized wheezing. Typical findings include a productive cough, dyspnea, hemoptysis (initially blood-tinged sputum, possibly leading to massive hemorrhage), anorexia, and weight loss. Upper extremity edema and chest pain may also occur.

Chemical pneumonitis (acute)

Mucosal injury causes increased secretions and edema, leading to wheezing, dyspnea, orthopnea, crackles, malaise, fever, and a productive cough with purulent sputum. The patient may also have signs of conjunctivitis, pharyngitis, laryngitis, and rhinitis.

Emphysema

Mild to moderate wheezing may occur with emphysema, a form of chronic obstructive pulmonary disease. Related findings include dyspnea, tachypnea, diminished breath sounds, peripheral cyanosis, pursed-lip breathing, anorexia, and malaise. Accessory muscle use, barrel chest, a chronic productive cough, and clubbing may also occur.

Inhalation injury

Wheezing may eventually occur. Early findings include hoarseness and coughing, singed nasal hairs, orofacial burns, and soot-stained sputum. Later effects are crackles, rhonchi, and respiratory distress.

Pneumothorax (tension)

A life-threatening disorder, tension pneumothorax causes respiratory distress with possible wheezing, dyspnea, tachycardia, tachypnea, and sudden, severe, sharp chest pain (commonly unilateral). Other findings include a dry cough, cyanosis, accessory muscle use, asymmetrical chest wall movement, anxiety, and restlessness. Examination reveals hyperresonance or tympany and diminished or absent breath sounds on the affected side, subcutaneous crepitation, decreased vocal fremitus, and tracheal deviation.

Pulmonary coccidioidomycosis

Pulmonary coccidiodomycosis may cause wheezing and rhonchi along with cough, fever, chills, pleuritic chest pain, headache, weakness, malaise, anorexia, and a macular rash.

Pulmonary edema

Wheezing may occur with pulmonary edema, a life-threatening disorder. Other signs and symptoms include coughing, exertional and paroxysmal nocturnal dyspnea and, later, orthopnea. Examination reveals tachycardia, tachypnea, dependent crackles, and a diastolic gallop. Severe pulmonary edema produces rapid, labored respirations and a productive cough with frothy, bloody sputum. The patient may also exhibit diffuse crackles, arrhythmias, hypotension, a thready pulse, and cold, clammy, cyanotic skin.

Pulmonary embolus

Rarely, diffuse, mild wheezing occurs in pulmonary embolus. The condition is characterized by dyspnea, chest pain, and cyanosis.

Pulmonary tuberculosis

In late stages, fibrosis causes wheezing. Common findings include a mild to severe productive cough with pleuritic chest pain and fine crackles, night sweats, anorexia, weight loss, fever, malaise, dyspnea, and fatigue. Other features are dullness on percussion, increased tactile fremitus, and amphoric breath sounds.

Thyroid goiter

Tracheobronchitis

Auscultation may detect wheezing, rhonchi, and crackles. The patient also has cough, slight fever, sudden chills, muscle and back pain, and substernal tightness.

Wegener’s granulomatosis

Wegener’s granulomatosis may cause mild to moderate wheezing if it compresses major airways. Other findings include cough (possibly bloody), dyspnea, pleuritic chest pain, hemorrhagic skin lesions, and progressive renal failure. Epistaxis and severe sinusitis are common.

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Stridor: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Airway trauma

Local trauma to the upper airway commonly causes acute obstruction, resulting in the sudden onset of stridor. Accompanying this sign are dysphonia, dysphagia, hemoptysis, cyanosis, accessory muscle use, intercostal retractions, nasal flaring, tachypnea, progressive dyspnea, and shallow respirations. Palpation may reveal subcutaneous crepitation in the neck or upper chest.

Anaphylaxis

With a severe allergic reaction (anaphylaxis), upper airway edema and laryngospasm cause stridor and other signs and symptoms of respiratory distress: nasal flaring, wheezing, accessory muscle use, intercostal retractions, and dyspnea. The patient may also develop nasal congestion and profuse, watery rhinorrhea. Typically, these respiratory effects are preceded by a feeling of impending doom or fear, weakness, diaphoresis, sneezing, nasal pruritus, urticaria, erythema, and angioedema. Common associated findings of anaphylaxis include chest or throat tightness, dysphagia and, possibly, signs of shock, such as hypotension, tachycardia, and cool, clammy skin.

Anthrax (inhalation)

Initial signs and symptoms of inhalation anthrax are flulike and include fever, chills, weakness, cough, and chest pain. The disease generally occurs in two stages with a period of recovery after the initial symptoms. The second stage develops abruptly with rapid deterioration marked by stridor, fever, dyspnea, and hypotension generally leading to death within 24 hours.

Aspiration of a foreign body

Sudden stridor is characteristic in this life-threatening situation. Related findings include abrupt onset of dry, paroxysmal coughing, gagging or choking, hoarseness, tachycardia, wheezing, dyspnea, tachypnea, intercostal muscle retractions, diminished breath sounds, cyanosis, and shallow respirations. The patient typically appears anxious and distressed.

Epiglottiditis

With epiglottiditis, a life-threatening inflammatory condition, stridor is caused by an erythematous, edematous epiglottis that obstructs the upper airway. Stridor occurs along with fever, sore throat, and a croupy cough. The cough may progress to severe respiratory distress with sternal and intercostal retractions, nasal flaring, cyanosis, and tachycardia.

Hypocalcemia

With hypocalcemia, laryngospasm can cause stridor. Other findings include paresthesia, carpopedal spasm, hyperactive deep tendon reflexes, muscle twitching and cramping, and positive Chvostek’s and Trousseau’s signs.

Inhalation injury

Within 48 hours after inhalation of smoke or noxious fumes, the patient may develop laryngeal edema and bronchospasms, resulting in stridor. Associated signs and symptoms include singed nasal hairs, orofacial burns, coughing, hoarseness, sooty sputum, crackles, rhonchi, wheezes, and other signs and symptoms  of respiratory distress, such as dyspnea, accessory muscle use, intercostal retractions, and nasal flaring.

Laryngeal tumor

Stridor is a late sign of laryngeal tumor and may be accompanied by dysphagia, dyspnea, enlarged cervical nodes, and pain that radiates to the ear. Typically, stridor is preceded by hoarseness, minor throat pain, and a mild, dry cough.

Laryngitis (acute)

Acute laryngitis may cause severe laryngeal edema, resulting in stridor and dyspnea. Its chief sign, however, is mild to severe hoarseness, perhaps with transient voice loss. Other findings include sore throat, dysphagia, dry cough, malaise, and fever.

Mediastinal tumor

Commonly producing no symptoms at first, a mediastinal tumor may eventually compress the trachea and bronchi, resulting in stridor. Its other effects include hoarseness, brassy cough, tracheal shift or tug, dilated neck veins, swelling of the face and neck, stertorous respirations, and suprasternal retractions on inspiration. The patient may also report dyspnea, dysphagia, and pain in the chest, shoulder, or arm.

Thoracic aortic aneurysm

If a thoracic aortic aneurysm compresses the trachea, it may cause stridor accompanied by dyspnea, wheezing, and a brassy cough. Other findings include hoarseness or complete voice loss, dysphagia, jugular vein distention, prominent chest veins, tracheal tug, paresthesia or neuralgia, and edema of the face, neck, and arms. The patient may also complain of substernal, lower back, abdominal, or shoulder pain.

Other causes

Diagnostic tests

Bronchoscopy or laryngoscopy may precipitate laryngospasm and stridor.

Treatments

After prolonged intubation, the patient may exhibit laryngeal edema and stridor when the tube is removed. Aerosol therapy with epinephrine may reduce stridor. Reintubation may be necessary in some cases. Neck surgery, such as thyroidectomy, may cause laryngeal paralysis and stridor.

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Wheezing: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Anaphylaxis

Anaphylaxis is an allergic reaction that can cause tracheal edema or bronchospasm, resulting in severe wheezing and stridor. Initial signs and symptoms of anaphylaxis include fright, weakness, sneezing, dyspnea, nasal pruritus, urticaria, erythema, and angioedema. Respiratory distress occurs with nasal flaring, accessory muscle use, and intercostal retractions. Other findings include nasal edema and congestion; profuse, watery rhinorrhea; chest or throat tightness; and dysphagia. Cardiac effects include arrhythmias and hypotension.

Aspiration of a foreign body

Partial obstruction by a foreign body produces sudden onset of wheezing and possibly stridor; a dry, paroxysmal cough; gagging; and hoarseness. Other findings include tachycardia, dyspnea, decreased breath sounds, and possibly cyanosis. A retained foreign body may cause inflammation leading to fever, pain, and swelling.

Aspiration pneumonitis

With aspiration pneumonitis, wheezing may accompany tachypnea, marked dyspnea, cyanosis, tachycardia, fever, productive (eventually purulent) cough, and pink, frothy sputum.

Asthma

Wheezing is an initial and cardinal sign of asthma. It’s heard at the mouth during expiration. An initially dry cough later becomes productive with thick mucus. Other findings include apprehension, prolonged expiration, intercostal and supraclavicular retractions, rhonchi, accessory muscle use, nasal flaring, and tachypnea. Asthma also produces tachycardia, diaphoresis, and flushing or cyanosis.

Bronchial adenoma

Bronchial adenoma is an insidious disorder that produces unilateral, possibly severe wheezing. Common features are chronic cough and recurring hemoptysis. Symptoms of airway obstruction may occur later.

Bronchiectasis

With bronchiectasis, excessive mucus commonly causes intermittent and localized or diffuse wheezing. A copious, foul-smelling, mucopurulent cough is classic. The cough is accompanied by hemoptysis, rhonchi, and coarse crackles. Weight loss, fatigue, weakness, exertional dyspnea, fever, malaise, halitosis, and late-stage clubbing may also occur.

Bronchitis (chronic)

Chronic bronchitis causes wheezing that varies in severity, location, and intensity. Associated findings include prolonged expiration, coarse crackles, scattered rhonchi, and a hacking cough that later becomes productive. Other effects include dyspnea, accessory muscle use, barrel chest, tachypnea, clubbing, edema, weight gain, and cyanosis.

Bronchogenic carcinoma

Obstruction from bronchogenic carcinoma may cause localized wheezing. Typical findings include a productive cough, dyspnea, hemoptysis (initially blood-tinged sputum, possibly leading to massive hemorrhage), anorexia, and weight loss. Upper extremity edema and chest pain may also occur.

Chemical pneumonitis (acute)

With acute chemical pneumonitis, mucosal injury causes increased secretions and edema, leading to wheezing, dyspnea, orthopnea, crackles, malaise, fever, and a productive cough with purulent sputum. The patient may also have signs of conjunctivitis, pharyngitis, laryngitis, and rhinitis.

Emphysema

Mild to moderate wheezing may occur with emphysema, a form of chronic obstructive pulmonary disease. Related findings include dyspnea, malaise, tachypnea, diminished breath sounds, peripheral cyanosis, pursed-lip breathing, anorexia, and malaise. Accessory muscle use, barrel chest, a chronic productive cough, and clubbing may also occur.

Inhalation injury

Wheezing may eventually occur with inhalation injury. Early findings include hoarseness and coughing, singed nasal hairs, orofacial burns, and soot-stained sputum. Later effects are crackles, rhonchi, and respiratory distress.

Pneumothorax (tension)

Tension pneumothorax, a life-threatening disorder, causes respiratory distress with possible wheezing, dyspnea, tachycardia, tachypnea, and sudden, severe, sharp chest pain (often unilateral). Other findings include a dry cough, cyanosis, accessory muscle use, asymmetrical chest wall movement, anxiety, and restlessness. Examination reveals hyperresonance or tympany and diminished or absent breath sounds on the affected side, subcutaneous crepitation, decreased vocal fremitus, and tracheal deviation.

Pulmonary coccidioidomycosis

Pulmonary coccidioidomycosis may cause wheezing and rhonchi along with cough, fever, chills, pleuritic chest pain, headache, weakness, fatigue, sore throat, backache, malaise, anorexia, and an itchy, macular rash.

Pulmonary edema

Wheezing may occur with pulmonary edema , a life-threatening disorder. Other signs and symptoms of pulmonary edema include coughing, exertional and paroxysmal nocturnal dyspnea and, later, orthopnea. Examination reveals tachycardia, tachypnea, dependent crackles, and a diastolic gallop. Severe pulmonary edema produces rapid, labored respirations; diffuse crackles; a productive cough with frothy, bloody sputum; arrhythmias; cold, clammy, cyanotic skin; hypotension; and thready pulse.

Pulmonary tuberculosis

In late stages, fibrosis causes wheezing. Common findings include a mild to severe productive cough with pleuritic chest pain and fine crackles, night sweats, anorexia, weight loss, fever, malaise, dyspnea, and fatigue. Other features are dullness to percussion, increased tactile fremitus, and amphoric breath sounds.

CULTURAL CUE:Those living in Appalachian regions have a 50% higher mortality from tuberculosis than the national average. They also have a higher incidence of pneumonia, influenza, and black lung disease. The higher rate of respiratory tract diseases may be related to the high-risk occupations of the region, such as those in the mining, timber, and textile industries.

Thyroid goiter

Thyroid goiter may not produce symptoms, or it may cause wheezing, dysphagia, and respiratory difficulty related to a compressed airway. The neck will appear swollen and distended.

Tracheobronchitis

Auscultation of the patient with tracheobronchitis may detect wheezing, rhonchi, and moist or coarse crackles. The patient also has a cough, slight fever, sudden chills, muscle and back pain, and substernal tightness.

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Wheezing: Principal Causes of Wheezing
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Asthma
2. Bronchiolitis
3. Pneumonia
4. Foreign body
5. Bronchopulmonary dysplasia
6. Cystic fibrosis
7. Cardiac failure
8. Bronchial obstruction
9. Anaphylaxis
10. Gastroesophageal reflux
11. Allergic bronchopulmonary aspergillosis
12. Psychogenic

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Stertor, Stridor, and Airway Obstruction: Principal Causes of Airway Obstruction
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Noseand nasopharynx
   1. Congenital
      1. Choanal atresia
      2. Craniofacial anomalies
      3. Midline masses
   2. Infection/inflammation
      1. Rhinitis
      2. Adenoid hypertrophy
      3. Polyps
   3. Trauma
   4. Neoplasm
2. Oropharynx and hypopharynx
   1. Congenital
      1. Micrognathiaand other skull base abnormalities
      2. Macroglossia
      3. Decreased pharyngeal muscle tone
   2. Infection/inflammation
      1. Tonsillarhypertrophy
      2. Abscess
   3. Foreign body
   4. Trauma
   5. Neoplasm
3. Supraglottic
   1. Congenital
      1. Laryngomalacia
      2. Laryngeal cyst and laryngocele
   2. Infection/inflammation
      1. Supraglottitis
      2. Gastroesophageal reflux
      3. Hereditary angioedema
   3. Trauma
   4. Neoplasm
4. Glottic
   1. Congenital
      1. Laryngeal web
      2. Laryngeal cleft
      3. Vocal cord paralysis
   2. Infection/inflammation
      1. Laryngitis
      2. Laryngeal spasm
   3. Foreign body
   4. Trauma
   5. Neoplasm
5. Subglottic
   1. Congenital
      1. Subglottic stenosis
      2. Cysts
   2. Infection/inflammation
      1. Croup
      2. Bacterial tracheitis
   3. Trauma
   4. Neoplasm
6. Tracheobronchial
   1. Congenital
      1. Tracheomalacia
      2. Tracheal web
      3. Tracheal cysts
      4. Tracheal stenosis
      5. Vascular anomalies
   2. Infection/inflammation
   3. Foreign body
   4. Trauma
   5. Neoplasm
      1. Tracheal
      2. Thyroid
      3. Mediastinal masses
7. Psychogenic

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Stridor: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Airway trauma.Local trauma to the upper airway commonly causes acute obstruction, resulting in the sudden onset of stridor. Accompanying this sign are dysphonia, dysphagia, hemoptysis, cyanosis, accessory muscle use, intercostal retractions, nasal flaring, tachypnea, progressive dyspnea, and shallow respirations. Palpation may reveal subcutaneous crepitation in the neck or upper chest.

Anaphylaxis.With a severe allergic reaction, upper airway edema and laryngospasm cause stridor and other signs and symptoms of respiratory distress: nasal flaring, wheezing, accessory muscle use, intercostal retractions, and dyspnea. The patient may also develop nasal congestion and profuse, watery rhinorrhea. Typically, these respiratory effects are preceded by a feeling of impending doom or fear, weakness, diaphoresis, sneezing, nasal pruritus, urticaria, erythema, and angioedema. Common associated findings include chest or throat tightness, dysphagia and, possibly, signs of shock, such as hypotension, tachycardia, and cool, clammy skin.

Anthrax (inhalation).Initial signs and symptoms of anthrax are flulike and include fever, chills, weakness, cough, and chest pain. The disease generally occurs in two stages with a period of recovery after the initial symptoms. The second stage develops abruptly with rapid deterioration marked by stridor, fever, dyspnea, and hypotension generally leading to death within 24 hours. Radiologic findings include mediastinitis and symmetric mediastinal widening.

Hypocalcemia.With hypocalcemia, laryngospasm can cause stridor. Other findings include paresthesia, carpopedal spasm, and positive Chvostek's and Trousseau's signs.

Inhalation injury.Within 48 hours after inhalation of smoke or noxious fumes, the patient may develop laryngeal edema and bronchospasms, resulting in stridor. Associated signs and symptoms include singed nasal hairs, orofacial burns, coughing, hoarseness, sooty sputum, crackles, rhonchi, wheezes, and other signs and symptoms of respiratory distress, such as dyspnea, accessory muscle use, intercostal retractions, and nasal flaring.

Mediastinal tumor.Commonly producing no symptoms at first, a mediastinal tumor may eventually compress the trachea and bronchi, resulting in stridor. Its other effects include hoarseness, a brassy cough, a tracheal shift or tug, dilated neck veins, swelling of the face and neck, stertorous respirations, and suprasternal retractions on inspiration. The patient may also report dyspnea, dysphagia, and pain in the chest, shoulder, or arm.

Retrosternal thyroid.Retrosternal thyroid causes stridor, dysphagia, cough, hoarseness, and tracheal deviation. It can also cause signs of thyrotoxicosis.

Other causes

Diagnostic tests.Bronchoscopy or laryngoscopy may precipitate laryngospasm and stridor.

Foreign body aspiration.Sudden stridor is characteristic in foreign body aspiration, a life-threatening situation. Related findings include an abrupt onset of dry, paroxysmal coughing; gagging or choking; hoarseness; tachycardia; wheezing; dyspnea; tachypnea; intercostal muscle retractions; diminished breath sounds; cyanosis; and shallow respirations. The patient typically appears anxious and distressed.

Treatments.After prolonged intubation, the patient may exhibit laryngeal edema and stridor when the tube is removed. Aerosol therapy with epinephrine may reduce stridor. Reintubation may be necessary in some cases. Neck surgery, such as thyroidectomy, may cause laryngeal paralysis and stridor.

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Wheezing [Sibilant rhonchi]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Anaphylaxis.Anaphylaxis can cause tracheal edema or bronchospasm, resulting in severe wheezing and stridor. Initial signs and symptoms include fright, weakness, sneezing, dyspnea, nasal pruritus, urticaria, erythema, and angioedema. Respiratory distress occurs with nasal flaring, accessory muscle use, and intercostal retractions. Other findings include nasal edema and congestion; profuse, watery rhinorrhea; chest or throat tightness; and dysphagia. Cardiac effects include arrhythmias and hypotension.

Aspiration pneumonitis.With aspiration pneumonitis, wheezing may accompany tachypnea, marked dyspnea, cyanosis, tachycardia, fever, productive (eventually purulent) cough, and pink, frothy sputum.

Asthma.Wheezing is an initial and cardinal sign of asthma. It's heard at the mouth during expiration. An initially dry cough later becomes productive with thick mucus. Other findings include apprehension, prolonged expiration, intercostal and supraclavicular retractions, rhonchi, accessory muscle use, nasal flaring, and tachypnea. Asthma also produces tachycardia, diaphoresis, and flushing or cyanosis.

Blast lung injury.Wheezing is a common symptom of blast lung injury, which is characterized by hypoxia and respiratory difficulty. The forceful blast wave that follows an explosive detonation can cause serious lung injury, including hemorrhage, contusion, edema, and tearing. In addition to wheezing, patients may exhibit chest pain, dyspnea, cyanosis, and hemoptysis. The diagnosis is confirmed by chest X-rays that show a classic “butterfly” pattern.

Bronchial adenoma.Bronchial adenoma produces unilateral, possibly severe wheezing. Common features are chronic cough and recurring hemoptysis. Symptoms of airway obstruction may occur later.

Bronchiectasis.With bronchiectasis, excessive mucus commonly causes intermittent and localized or diffuse wheezing. A copious, foul-smelling, mucopurulent cough is classic. It's accompanied by hemoptysis, rhonchi, and coarse crackles. Weight loss, fatigue, weakness, exertional dyspnea, fever, malaise, halitosis, and late-stage clubbing may also occur.

Bronchitis (chronic).Bronchitis causes wheezing that varies in severity, location, and intensity. Associated findings include prolonged expiration, coarse crackles, scattered rhonchi, and a hacking cough that later becomes productive. Other effects include dyspnea, accessory muscle use, barrel chest, tachypnea, clubbing, edema, weight gain, and cyanosis.

Bronchogenic carcinoma.Obstruction from bronchogenic carcinoma may cause localized wheezing. Typical findings include a productive cough, dyspnea, hemoptysis (initially blood-tinged sputum, possibly leading to massive hemorrhage), anorexia, and weight loss. Upper extremity edema and chest pain may also occur.

Emphysema.Mild to moderate wheezing may occur with emphysema. Related findings include dyspnea, tachypnea, diminished breath sounds, peripheral cyanosis, pursed-lip breathing, anorexia, and malaise. Accessory muscle use, barrel chest, a chronic productive cough, and clubbing may also occur.

Pulmonary coccidioidomycosis.Pulmonary coccidioidomycosis may cause wheezing and rhonchi along with cough, fever, chills, pleuritic chest pain, headache, weakness, malaise, anorexia, and macular rash.

Pulmonary edema.Wheezing may occur with pulmonary edema, a life-threatening disorder. Other signs and symptoms include coughing, exertional and paroxysmal nocturnal dyspnea and, later, orthopnea. Examination reveals tachycardia, tachypnea, dependent crackles, and a diastolic gallop. Severe pulmonary edema produces rapid, labored respirations; diffuse crackles; a productive cough with frothy, bloody sputum; arrhythmias; cold, clammy, cyanotic skin; hypotension; and thready pulse.

Respiratory syncytial virus (RSV).Individuals infected with RSV commonly develop wheezing and other symptoms within 4 to 6 days of exposure to this virus. Healthy adults and children older than age 3 usually have mild cases of RSV and experience wheezing along with other common cold-like symptoms of runny nose, cough, and low-grade fever. In children ages 3 and younger, high-pitched expiratory wheezing can accompany a severe cough, rapid breathing, and high-grade fever.

Tracheobronchitis.With tracheobronchitis, auscultation may detect wheezing, rhonchi, and crackles. The patient also has a cough, slight fever, sudden chills, muscle and back pain, and substernal tightness.

Wegener's granulomatosis.Wegener's granulomatosis may cause mild to moderate wheezing if it compresses major airways. Other findings include a cough (possibly bloody), dyspnea, pleuritic chest pain, hemorrhagic skin lesions, and progressive renal failure. Epistaxis and severe sinusitis are common.

Other causes

Foreign body aspiration. Partial obstruction by a foreign body produces sudden onset of wheezing and possibly stridor; a dry, paroxysmal cough; gagging; and hoarseness. Other findings include tachycardia, dyspnea, decreased breath sounds and, possibly, cyanosis. A retained foreign body may cause inflammation leading to fever, pain, and swelling.

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Asthma as a complication of other conditions:

Other conditions that might have Asthma as a complication may, potentially, be an underlying cause of Asthma. Our database lists the following as having Asthma as a complication of that condition:

• Bronchiolitis
• Dextrocardia-bronchiectasis-sinusitis
• Mold allergies
• Whooping Cough

Asthma as a symptom:

Conditions listing Asthma as a symptom may also be potential underlying causes of Asthma. Our database lists the following as having Asthma as a symptom of that condition:

• Allergies
• Asthma-related traits, susceptibility to, 1
• Asthma-related traits, susceptibility to, 2
• Asthma-related traits, susceptibility to, 3
• Asthma-related traits, susceptibility to, 4
• Asthma-related traits, susceptibility to, 5
• Asthma-related traits, susceptibility to, 6
• Asthma-related traits, susceptibility to, 7
• Food allergies
• Gastro-enteropancreatic neuroendocrine tumor
• Gulf War syndrome
• Hay fever
• Oculopalatocerebral syndrome
• Peanut Allergy
• Polyarteritis nodosa
• Rice millers' syndrome
• Roundworm
• Thymus Cancer
• Thymus disorders
• Wells syndrome

Medications or substances causing Asthma:

The following drugs, medications, substances or toxins are some of the possible causes of Asthma as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

• Carboprost Tromethamine
• Hemabate
• Caramiphen and Phenylpropanolamine
• Ordrine AT Extended Release Capsule
• Rescaps-D S.R. Capsule

See full list of 199 medications causing Asthma

What triggers Asthma?

The following conditions are listed as possible triggers for Asthma:

• Various things can exacerbate asthma or trigger asthma attacks:
  • Allergen exposure
  • Pollens
  • House dust mites
  • Molds
  • Cockroaches
  • Viral respiratory infections
  • Common cold
  • Flu
  • Tobacco smoke
  • Certain environmental pollutants
  • Fumes
  • Air pollution
  • Strong odors
  • Exercise
  • Yelling
  • Crying
  • Laughing
  • Stress
  • Weather changes
  • Cold air
  • Aspirin
  • Certain medications
  • Pets
  • Birds
  • Farm animals
  • Car exhaust fumes

Medical news summaries relating to Asthma:

The following medical news items are relevant to causes of Asthma:

• 40% of city’s young children have asthma
• A special CT scan to image asthma effects
• Asthma gene variants linked with brain cancer
• Asthma hospitalization an unacceptable first-line treatment
• Bakery workers more prone to asthma symptoms
• Beuty and home products have been found to produce health harming chemicals
• Breastfeeding may delay onset of food allergies
• Change in climate to greatly affect health
• Childhood asthma is a chronic problem
• Childhood obesity tripling in concern
• Children with genetic defect face greater health risks from passive smoking
• Cockroach allergy very common
• Congenital second hand smoke risks lung disease
• Dust mite allergy
• Dust mites can’t survive in unmade beds
• Eczema may be a sign of other allergic conditions
• Eosonophil presence directly linked to asthma
• Excess weight is linked to a myriad of diseases
• Exercise is often a trigger for an asthma attack
• Exposure to indoor pool airborne chemicals may increase asthma risk in children
• Exposure to mould increases risk of childhood asthma
• Farm children less likely to suffer from asthma
• Grape farmers more prone to respiratory problems
• Gulf War Veterans want more studies done to determine link between their symptoms and their service in the war
• High levels of vitamin C in breast milk linked to lower allergy risk
• High salt consumption can cause a range of health problems
• Household chemical linked to asthma risk
• Indoor air purifiers produce dangerous levels of ozone
• New asthma drug has novel approach
• New drug strategy for asthmatics
• Obese women might be misdiagnosed with asthma
• Oral allergy syndrome
• Overweight asthmatics should be encouraged to lose weight
• Researchers report on how to reduce asthma risk in children
• Smoking addiction
• Soy allergy sufferers need to be wary of many foods
• Statins to be trialed as asthma drug
• Stepwise guide to managing asthma
• Stomach microflora found to be responsible for allergen tolerance
• Stress can trigger short term and long term responses in asthmatics
• Study linking asthma to use of cleaning products is misleading says The Soap and Detergent Association
• Surgery may reduce asthma
• Suspicion of asthma
• Therapy to reduce allergies to cats
• Unmade beds can exterminate dust mites
• Vitamin C supplementation during pregnancy may increase the risk of wheezing but vitamin E may decrease the risk
• Worm treatment for asthmatics

Related information on causes of Asthma:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Asthma may be found in:

• Risk factors for Asthma
• Medications that may cause Asthma
• Genetics of Asthma
• Hidden causes of Asthma