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Diseases » Sleep apnea » Causes

Causes of Sleep apnea



Contents

List of causes of Sleep apnea

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Sleep apnea) that could possibly cause Sleep apnea includes:

More causes: see full list of causes for Sleep apnea

Sleep apnea as a complication of other conditions:

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

Sleep apnea as a symptom:

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

Medications or substances causing Sleep apnea:

The following drugs, medications, substances or toxins are some of the possible causes of Sleep apnea 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.

See full list of 7 medications causing Sleep apnea


What causes Sleep apnea?

Article excerpts about the causes of Sleep apnea:
Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. In some people, apnea occurs when the throat muscles and tongue relax during sleep and partially block the opening of the airway. When the muscles of the soft palate at the base of the tongue and the uvula (the small fleshy tissue hanging from the center of the back of the throat) relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether. (Source: excerpt from Sleep Apnea: NWHIC)

Medical news summaries relating to Sleep apnea:

The following medical news items are relevant to causes of Sleep apnea:

Related information on causes of Sleep apnea:

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

Causes of Sleep apnea: Online Medical Books

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

Paroxysmal Nocturnal Dyspnea: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • CHF is the most common cause
    –Etiologies include uncontrolled HTN, pulmonary embolus, endocarditis, hyperthyroidism, pericardial disease, endocardial disease (e.g., valvular stenosis, insufficiency, rupture, endocarditis), and myocardial disease (e.g., MI, ischemia, arrhythmias)
  • Mitral stenosis
    –Almost always secondary to rheumatic heart disease (after 15–40 years)
    –Advanced cases result in pulmonary hypertension and right heart failure
    –Dyspnea is the most significant symptom
    –Classic triad: Diastolic rumble, opening snap, and loud first heart sound
  • Aortic regurgitation
    –Most commonly due to rheumatic fever
  • Cardiomyopathies
    –Abnormal myocardium, resulting in impaired cardiac output and CHF
  • Aortic stenosis
    –Due to senile valve degeneration, rheumatic disease, or congenital
    –Associated with angina, syncope, and CHF
  • Congenital heart disease
    –May see failure to thrive, progressive CHF symptoms, cyanosis, and/or murmur
    • “Cardiac asthma”
      –Bronchospasm secondary to pulmonary congestion and interstitial edema that compresses small airways
      –Standing decreases lung congestion
    • Anxiety
    • Severe COPD and emphysema
    • Asthma
    • Obstructive sleep apnea
    • Obesity/hypoventilation
    • Tropical pulmonary eosinophilia (filariasis)

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

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)

Wheezing
  • 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)
  • COPD
  • GERD
  • Respiratory infection
    –Upper respiratory infection
    –Bronchiolitis
    –“Atypical” pneumonia
    • Aspirated foreign body
      –Abrupt onset of unilateral wheezing or stridor (if lodged in the upper airway), cough, and decreased breath sounds
  • Allergic reaction/anaphylaxis
    –Urticaria, throat swelling (angioedema), and lip/tongue edema may be present

    • » READ BOOK EXCERPT ONLINE »

    Source: In a Page: Signs and Symptoms, 2004

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

      • Much apnea is physiologic and normal
        –Post-sigh apnea is normal
        –Newborns, especially premature babies, may have irregular breathing as their respiratory control center matures
        –Periodic breathing at high altitude
    • Prolonged apnea is respiratory arrest, and inadequate ventilation is respiratory failure, and both require immediate intervention
    • Apnea may be divided into central, obstructive, and mixed apnea; etiologies vary by age
    • Central apnea in infants
      –Apnea of prematurity
      –Congenital central hypoventilation syndrome (CCHS, or Ondine curse)
      –CNS depression (sepsis, shock, drug effect, RSV, seizure or postictal state)
      –Respiratory muscle failure (e.g., myotonia, infantile botulism)
      • Obstructive apnea in infants
        –Upper airway obstruction (severe laryngomalacia, choanal atresia, macroglossia, micrognathia, subglottic stenosis or web, laryngospasm)
        –Lower airway: Rarely causes obstructive apnea (tracheal stenosis, rings, slings)
      • Central apnea in children
        –CNS (drug-induced CNS depression, CCHS, abnormal CNS brainstem anatomy and function, sepsis/septic shock)
        –Respiratory muscle failure (muscular dystrophy, myotonia, myasthenia gravis)
      • Obstructive apnea in children
        –Upper airway obstruction, obstructive sleep apnea syndrome (OSAS), tonsillar and adenoidal hypertrophy, macroglossia, micrognathia, subglottic stenosis, laryngospasm
      • Mixed apnea
        –CNS depression and decreased upper airway tone
        –Gastroesophageal reflux leading to increased parasympathetic activity and/or laryngospasm
        –Respiratory muscle failure and adenoidal hypertrophy
      • Apparent life-threatening events (ALTE)
      • Trauma may cause apnea at any age

    » READ BOOK EXCERPT ONLINE »

    Source: In A Page: Pediatric Signs and Symptoms, 2007

    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)

    » READ BOOK EXCERPT ONLINE »

    Source: In A Page: Pediatric Signs and Symptoms, 2007

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

    ❑ Airway obstruction. Occlusion or compression of the trachea, central airways, or smaller airways can cause sudden apnea by blocking the patient’s airflow and producing acute respiratory failure.

    ❑ Brain stem dysfunction. Primary or secondary brain stem dysfunction can cause apnea by destroying the brain stem’s ability to initiate respirations. Apnea may arise suddenly (as in trauma, hemorrhage, or infarction) or gradually (as in degenerative disease or tumor). Apnea may be preceded by a decreased LOC and by various motor and sensory deficits.

    ❑ Neuromuscular failure. Trauma or disease can disrupt the mechanics of respiration, causing sudden or gradual apnea. Associated findings include diaphragmatic or intercostal muscle paralysis from injury or respiratory weakness or paralysis from acute or degenerative disease.

    ❑ Parenchymatous lung disease. An accumulation of fluid within the alveoli produces apnea by interfering with pulmonary gas exchange and producing acute respiratory failure. Apnea may arise suddenly, as in near drowning and acute pulmonary edema, or gradually, as in emphysema. Apnea may also be preceded by crackles and labored respirations with accessory muscle use.

    ❑ Pleural pressure gradient disruption. Conversion of normal negative pleural air pressure to positive pressure by chest wall injuries (such as flail chest) causes lung collapse, producing respiratory distress and, if untreated, apnea. Associated signs include an asymmetrical chest wall and asymmetrical or paradoxical respirations.

    ❑ Pulmonary capillary perfusion decrease. Apnea can stem from obstructed pulmonary circulation, most commonly due to heart failure or lack of circulatory patency. It occurs suddenly in cardiac arrest, massive pulmonary embolism, and most cases of severe shock. In contrast, it occurs progressively in septic shock and pulmonary hypertension. Related findings include hypotension, tachycardia, and edema.

    Other causes

    ❑ Drugs. Central nervous system (CNS) depressants may cause hypoventilation and apnea. Benzodiazepines may cause respiratory depression and apnea when given I.V. along with other CNS depressants to elderly or acutely ill patients.

    Neuromuscular blockers — such as curariform drugs and anticholinesterases — may produce sudden apnea because of respiratory muscle paralysis.

    ❑ Sleep-related apneas. These repetitive apneas occur during sleep from airflow obstruction or brain stem dysfunction.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

    Paroxysmal nocturnal dyspnea: Medical causes
    (Handbook of Signs & Symptoms (Third Edition))

    Left-sided heart failure

    Dyspnea — on exertion, during sleep, and eventually even at rest — is an early sign of left-sided heart failure. This sign is characteristically accompanied by Cheyne-
    Stokes respirations, diaphoresis, weakness, wheezing, and a persistent, nonproductive cough or a cough that produces clear or blood-tinged sputum. As the patient’s condition worsens, he develops tachycardia, tachypnea, alternating pulse (commonly initiated by a premature beat), a ventricular gallop, crackles, and peripheral edema.

    With advanced left-sided heart failure, the patient may also exhibit severe orthopnea, cyanosis, clubbing, hemoptysis, and cardiac arrhythmias as well as signs and symptoms of shock, such as hypotension, a weak pulse, and cold, clammy skin.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

    Respirations, stertorous: Medical causes
    (Handbook of Signs & Symptoms (Third Edition))

    Airway obstruction

    Regardless of its cause, partial airway obstruction may lead to stertorous respirations accompanied by wheezing, dyspnea, tachypnea and, later, intercostal retractions and nasal flaring. If the obstruction becomes complete, the patient abruptly loses his ability to talk and displays diaphoresis, tachycardia, and inspiratory chest movement but absent breath sounds. Severe hypoxemia rapidly ensues, resulting in cyanosis, loss of consciousness, and cardiopulmonary collapse.

    Obstructive sleep apnea

    Loud and disruptive snoring is a major characteristic of obstructive sleep apnea, which commonly affects people who are obese. Typically, the snoring alternates with periods of sleep apnea, which usually end with loud gasping sounds. Alternating tachycardia and bradycardia may occur.

    Episodes of snoring and apnea recur in a cyclic pattern throughout the night. Sleep disturbances, such as somnambulism and talking during sleep, may also occur. Some patients display hypertension and ankle edema. Most awaken in the morning with a generalized headache, feeling tired and unrefreshed. The most common complaint is excessive daytime sleepiness. Lack of sleep may cause depression, hostility, and decreased mental acuity.

    Other causes

    Endotracheal (ET) intubation, suction, or surgery

    ET intubation, suction, or surgery may cause significant palatal or uvular edema, resulting in stertorous respirations.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

    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.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

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

    Airway obstruction

    Occlusion or compression of the trachea, central airways, or smaller airways can cause sudden apnea by blocking the patient’s airflow and producing acute respiratory failure.

    Brain stem dysfunction

    Primary or secondary brain stem dysfunction can cause apnea by destroying the brain stem’s ability to initiate respirations. Apnea may arise suddenly (as in trauma, hemorrhage, or infarction) or gradually (as in degenerative disease or tumor). Apnea may be preceded by decreased LOC and various motor and sensory deficits.

    Neuromuscular failure

    Trauma or disease can disrupt the mechanics of respiration, causing sudden or gradual apnea. Associated findings include diaphragmatic or intercostal muscle paralysis from injury, or respiratory weakness or paralysis from acute or degenerative disease.

    Parenchymatous lung disease

    An accumulation of fluid within the alveoli produces apnea by interfering with pulmonary gas exchange and producing acute respiratory failure. Apnea may arise suddenly, as in near drowning and acute pulmonary edema, or gradually, as in emphysema. Apnea also may be preceded by crackles and labored respirations with accessory muscle use.

    Pleural pressure gradient disruption

    Conversion of normal negative pleural air pressure to positive pressure by chest wall injuries (such as flail chest) causes lung collapse, producing respiratory distress and, if untreated, apnea. Associated signs include an asymmetrical chest wall and asymmetrical or paradoxical respirations.

    Pulmonary capillary perfusion decrease

    Apnea can stem from obstructed pulmonary circulation, most commonly due to heart failure or lack of circulatory patency. It occurs suddenly in cardiac arrest, massive pulmonary embolism, and most cases of severe shock; it occurs progressively in septic shock and pulmonary hypertension. Related findings include hypotension, tachycardia, and edema.

    Other causes

    Drugs

    Central nervous system (CNS) depressants may cause hypoventilation and apnea. Benzodiazepines may cause respiratory depression and apnea when given I.V. along with other CNS depressants to elderly or acutely ill patients.

    Neuromuscular blockers—such as curariform drugs and anticholinesterases— may produce sudden apnea due to respiratory muscle paralysis.

    Sleep-related apneas

    These repetitive apneas occur during sleep from airflow obstruction or brain stem dysfunction.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Paroxysmal nocturnal dyspnea: Medical causes
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Left-sided heart failure

    Dyspnea—on exertion, during sleep, and eventually even at rest—is an early sign of left-sided heart failure. This sign is characteristically accompanied by Cheyne-Stokes respirations, diaphoresis, weakness, wheezing, and a persistent, nonproductive cough or a cough that produces clear or blood-tinged sputum. As the patient’s condition worsens, he develops tachycardia, tachypnea, alternating pulse (commonly initiated by a premature beat), a ventricular gallop, crackles, and peripheral edema.

    With advanced left-sided heart failure, the patient may also exhibit severe orthopnea, cyanosis, clubbing, hemoptysis, and cardiac arrhythmias as well as signs and symptoms of shock, such as hypotension, weak pulse, and cold, clammy skin.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Respirations, stertorous: Medical causes
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Airway obstruction

    Regardless of its cause, partial airway obstruction may lead to stertorous respirations accompanied by wheezing, dyspnea, tachypnea and, later, intercostal retractions and nasal flaring. If the obstruction becomes complete, the patient abruptly loses his ability to talk and displays diaphoresis, tachycardia, and inspiratory chest movement but absent breath sounds. Severe hypoxemia rapidly ensues, resulting in cyanosis, loss of consciousness, and cardiopulmonary collapse.

    Obstructive sleep apnea

    Loud and disruptive snoring is a major characteristic of this syndrome, which commonly affects the obese. Typically, the snoring alternates with periods of sleep apnea, which usually end with loud gasping sounds. Alternating tachycardia and bradycardia may occur.

    Episodes of snoring and apnea recur in a cyclic pattern throughout the night. Sleep disturbances, such as somnambulism and talking during sleep, may also occur. Some patients display hypertension and ankle edema. Most awaken in the morning with a generalized headache, feeling tired and unrefreshed. The most common complaint is excessive daytime sleepiness. Lack of sleep may cause depression, hostility, and decreased mental acuity.

    Other causes

    Endotracheal intubation, suction, or surgery

    These procedures may cause significant palatal or uvular edema, resulting in stertorous respirations.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    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.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    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

    » READ BOOK EXCERPT ONLINE »

    Source: Field Guide to Bedside Diagnosis, 2007

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

    Airway obstruction

    Occlusion or compression of the trachea, central airways, or smaller airways can cause sudden apnea by blocking the patient’s airflow and producing acute respiratory failure.

    Brain stem dysfunction

    Primary or secondary brain stem dysfunction can cause apnea by destroying the brain stem’s ability to initiate respirations. Apnea may arise suddenly (as in trauma, hemorrhage, or infarction) or gradually (as in degenerative disease or a tumor). Apnea may be preceded by a decreased LOC and by various motor and sensory deficits.

    Neuromuscular failure

    Trauma or disease can disrupt the mechanics of respiration, causing sudden or gradual apnea. Associated findings include diaphragmatic or intercostal muscle paralysis from injury, or respiratory weakness or paralysis from acute or degenerative disease.

    Parenchymatous lung disease

    An accumulation of fluid within the alveoli produces apnea by interfering with pulmonary gas exchange and producing acute respiratory failure. Apnea may arise suddenly, as in near drowning and acute pulmonary edema, or gradually, as in emphysema. Apnea also may be preceded by crackles and labored respirations with accessory muscle use.

    Pleural pressure gradient disruption

    Conversion of normal negative pleural air pressure to positive pressure by chest wall injuries, such as flail chest, causes lung collapse, producing respiratory distress and, if untreated, apnea. Associated signs include an asymmetrical chest wall and asymmetrical or paradoxical respirations.

    Pulmonary capillary perfusion decrease

    Apnea can stem from obstructed pulmonary circulation, most commonly due to heart failure or lack of circulatory patency. It occurs suddenly in cardiac arrest, massive pulmonary embolism, and most cases of severe shock. In contrast, it occurs progressively in septic shock and pulmonary hypertension. Related findings include hypotension, tachycardia, and edema.

    Other causes

    Drugs

    CNS depressants may cause hypoventilation and apnea. Benzodiazepines may cause respiratory depression and apnea when given I.V. along with other CNS depressants to elderly or acutely ill patients.

    Neuromuscular blockers

    These medications, such as curariform drugs and anticholinesterases, may produce sudden apnea because of respiratory muscle paralysis.

    Sleep-related apnea

    These repetitive apneas occur during sleep from airflow obstruction or brain stem dysfunction.

    » READ BOOK EXCERPT ONLINE »

    Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

    Respirations, stertorous: Medical causes
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    Airway obstruction

    Regardless of its cause, partial airway obstruction may lead to stertorous respirations accompanied by wheezing, dyspnea, tachypnea and, later, intercostal retractions and nasal flaring. If the obstruction becomes complete, the patient abruptly loses his ability to talk and displays diaphoresis, tachycardia, and inspiratory chest movement but absent breath sounds. Severe hypoxemia rapidly ensues, resulting in cyanosis, loss of consciousness, and cardiopulmonary collapse.

    Obstructive sleep apnea

    Loud and disruptive snoring is a major characteristic of obstructive sleep apnea, which commonly affects the obese. Typically, snoring alternates with periods of sleep apnea, which usually end with loud gasping sounds. Alternating tachycardia and bradycardia may occur.

    Episodes of snoring and apnea recur in a cyclic pattern throughout the night. Sleep disturbances, such as somnambulism and talking during sleep, may also occur. Some patients display hypertension and ankle edema. Most awaken in the morning with a generalized headache, feeling tired and unrefreshed. The most common complaint is excessive daytime sleepiness. Lack of sleep may cause depression, hostility, and decreased mental acuity.

    Other causes

    Endotracheal intubation, suction, or surgery

    These procedures may cause significant palatal or uvular edema, resulting in stertorous respirations.

    » READ BOOK EXCERPT ONLINE »

    Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

    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

    Thyroid goiter may be asymptomatic, 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 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.

    » READ BOOK EXCERPT ONLINE »

    Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

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

    Airway obstruction

    Partial airway obstruction may lead to stertorous respirations accompanied by wheezing, dyspnea, tachypnea and, later, intercostal retractions and nasal flaring. If the obstruction becomes complete, the patient abruptly loses his ability to talk and displays diaphoresis, tachycardia, and inspiratory chest movement but absent breath sounds. Severe hypoxemia rapidly ensues, resulting in cyanosis, loss of consciousness, and cardiopulmonary collapse.

    Obstructive sleep apnea

    Loud and disruptive snoring is a major characteristic of obstructive sleep apnea, which commonly affects the obese. Typically, the snoring alternates with periods of sleep apnea, which usually end with loud gasping sounds. These episodes occur in a cyclic pattern throughout the night. Alternating tachycardia and bradycardia may occur as well as such sleep disturbances as somnambulism and talking during sleep. Some patients display hypertension and ankle edema. Most awaken in the morning with a generalized headache, feeling tired and unrefreshed. The most common complaint is excessive daytime sleepiness. Lack of sleep may cause depression, hostility, and decreased mental acuity.

    Other causes

    Procedures

    Endotracheal intubation, suction, or surgery may cause significant palatal or uvular edema, resulting in stertorous respirations.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    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.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    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

    » READ BOOK EXCERPT ONLINE »

    Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

    Respiratory Distress and Apnea: Principal Causes of Respiratory Distress (Neonatal)
    (The Diagnostic Approach to Symptoms and Signs in Pediatrics)

    1. Upperrespiratory tract obstruction
    2. Lower respiratory tract disorders
      1. Transienttachypnea of the newborn
      2. Respiratory distress syndrome (hyalinemembrane disease)
      3. Meconium aspiration and other aspirationsyndromes
      4. Pneumonia
      5. Pulmonary air leaks
      6. Pulmonary hemorrhage
      7. Bronchopulmonary dysplasia
      8. Congenital malformations of the lungs,bronchi, diaphragm, and rib cage
        1. Lung agenesis and aplasia
        2. Pulmonary hypoplasia
        3. Pulmonary sequestration
        4. Lobar emphysema
        5. Cystic lung lesions
          1. Bronchogeniccyst
          2. Congenital cystic adenomatoid malformation
          3. Intrapulmonary cysts
          4. Congenital pulmonary lymphangiectasia
        6. Chylothorax
        7. Bronchial malformations
        8. Diaphragm lesions
          1. Congenitaldiaphragmatic hernia
          2. Diaphragmatic eventration
          3. Diaphragmatic paralysis or paresis
        9. Rib cage anomalies
      9. Persistent fetal circulation
    3. Cardiac disorders
    4. Hematologic disorders
      1. Anemia
      2. Polycythemia
    5. Metabolic disorders
      1. Hypothermia
      2. Hypoglycemia
      3. Metabolic acidosis
    6. Neurologic and muscle disorders
      1. Braindisorders
      2. Spinal cord injury
      3. Neuromuscular disorders
    7. Drugs

    » READ BOOK EXCERPT ONLINE »

    Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

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

    Airway obstruction.Occlusion or compression of the trachea, central airways, or smaller airways can cause sudden apnea by blocking the patient's airflow and producing acute respiratory failure.

    Brain stem dysfunction.Primary or secondary brain stem dysfunction can cause apnea by destroying the brain stem's ability to initiate respirations. Apnea may arise suddenly (as in trauma, hemorrhage, or infarction) or gradually (as in degenerative disease or tumor). Apnea may be preceded by a decreased LOC and by various motor and sensory deficits.

    Neuromuscular failure.Trauma or disease can disrupt the mechanics of respiration, causing sudden or gradual apnea. Associated findings include diaphragmatic or intercostal muscle paralysis from injury or respiratory weakness or paralysis from acute or degenerative disease.

    Parenchymatous lung disease.An accumulation of fluid within the alveoli produces apnea by interfering with pulmonary gas exchange and producing acute respiratory failure. Apnea may arise suddenly, as in near drowning and acute pulmonary edema, or gradually, as in emphysema. Apnea may be preceded by crackles and labored respirations with accessory muscle use.

    Pleural pressure gradient disruption.Conversion of normal negative pleural air pressure to positive pressure by chest wall injuries (such as flail chest) causes lung collapse, producing respiratory distress and, if untreated, apnea. Associated signs include an asymmetrical chest wall and asymmetrical or paradoxical respirations.

    Pulmonary capillary perfusion
    decrease.    Apnea can stem from obstructed pulmonary circulation, most commonly due to heart failure or lack of circulatory patency. It occurs suddenly in cardiac arrest, massive pulmonary embolism, and most cases of severe shock. In contrast, it occurs progressively in septic shock and pulmonary hypertension. Related findings include hypotension, tachycardia, and edema.

    Other causes

    Drugs.Central nervous system (CNS) depressants may cause hypoventilation and apnea. Benzodiazepines may cause respiratory depression and apnea when given I.V. along with other CNS depressants to elderly or acutely ill patients. Drug overdose can lead to respiratory depression and apnea.

    Neuromuscular blockers—such as curariform drugs and anticholinesterases—may produce sudden apnea because of respiratory muscle paralysis.

    Sleep-related apneas.These repetitive apneas occur during sleep from airflow obstruction or brain stem dysfunction.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Paroxysmal nocturnal dyspnea: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Left-sided heart failure.Dyspnea—on exertion, during sleep, and eventually even at rest—is an early sign of left-sided heart failure. This sign is characteristically accompanied by Cheyne-Stokes respirations, diaphoresis, weakness, wheezing, and a persistent, nonproductive cough or a cough that produces clear or blood-tinged sputum. As the patient's condition worsens, he develops tachycardia, tachypnea, alternating pulse (commonly initiated by a premature beat), a ventricular gallop, crackles, and peripheral edema.

    With advanced left-sided heart failure, the patient may also exhibit severe orthopnea, cyanosis, clubbing, hemoptysis, and cardiac arrhythmias as well as signs and symptoms of shock, such as hypotension, a weak pulse, and cold, clammy skin.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Respirations, stertorous: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Airway obstruction.Regardless of its cause, partial airway obstruction may lead to stertorous respirations accompanied by wheezing, dyspnea, tachypnea and, later, intercostal retractions and nasal flaring. If the obstruction becomes complete, the patient abruptly loses his ability to talk and displays diaphoresis, tachycardia, and inspiratory chest movement but absent breath sounds. Severe hypoxemia rapidly ensues, resulting in cyanosis, loss of consciousness, and cardiopulmonary collapse.

    Obstructive sleep apnea.Loud and disruptive snoring is a major characteristic of obstructive sleep apnea, which commonly affects people who are obese. Typically, the snoring alternates with periods of sleep apnea, which usually end with loud gasping sounds. Alternating tachycardia and bradycardia may occur.

    Episodes of snoring and apnea recur in a cyclic pattern throughout the night. Sleep disturbances, such as somnambulism and talking during sleep, may also occur. Some patients display hypertension and ankle edema. Most awaken in the morning with a generalized headache, feeling tired and unrefreshed. The most common complaint is excessive daytime sleepiness. Lack of sleep may cause depression, hostility, and decreased mental acuity.

    Other causes

    Endotracheal (ET) intubation, suction, or surgery.ET intubation, suction, or surgery may cause significant palatal or uvular edema, resulting in stertorous respirations.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    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.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007


     » Next page: Risk Factors for Sleep apnea

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