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All That Wheezes Is Not Asthma

All That Wheezes Is Not Asthma. A Wheeze Is Not Always What It Seems To Be. Wheezing =. Continuous musical sound High pitched advantitia Bronchospasm Asthma COPD Bronchitis. Wheezing. Poly-phonic Multiple notes Whale call Small airway Mono-phonic Single note Stridor

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All That Wheezes Is Not Asthma

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  1. All That Wheezes Is Not Asthma A Wheeze Is Not Always What It Seems To Be

  2. Wheezing = • Continuous musical sound • High pitched advantitia • Bronchospasm • Asthma • COPD • Bronchitis

  3. Wheezing • Poly-phonic • Multiple notes • Whale call • Small airway • Mono-phonic • Single note • Stridor • Large airway

  4. Wheezing • Inspiratory • Expiratory • Focal/Local • Bronchial tumors, lymph anomolies, cysts

  5. Stridor or Wheeze • Stridor • Harsh noise caused by turbulent flow • Inspiratory = larynx • Expiratory = trachea • Biphasic = fixed lesion in periglotticregion • Stidor heard as a wheeze

  6. Differential diagnosis of wheezing due to upper airway diseases

  7. Differential diagnosis of wheezing due to lower airway diseases

  8. Physical Findings to Consider • Onset of Symptoms • Clearing of throat • Discharge/secretions • Pain • Response to BD • PFT results • FLOW VOLUME I & E • Heart burn • Changes in weight • SOB w/ exertion • Clubbing/Sx hypoxia • Smoking Hx • Short neck • Wheezing / Stridor/ Stertor • Quality • Location • Type

  9. Lower Airway Obstruction • Asthma • COPD • Pulm Edema • Aspiration • PE • Bronchiolitis • CF • Tumor • Infection

  10. Intrathoracic Large Airway Obstruction • Tracheal Stenosis • FBA • Tumors • Cysts • Goiter • Tracheo/bronchomegaly • Tracheal malacia • R aortic arch

  11. Extrathoracic Upper Airway Obstruction • Sinus drip • Vocal cord dysfunction • Arytenoid dysfuction • Tonsils • Supraglottitis • Laryngeal edema / stenosis • Granuloma • 2 Intubation • Wegener’s • Tumors • Anaphylaxis • Obesity • Laryngocele

  12. Laryngeal Disorders dilatation of right laryngeal ventricle (white arrow, C) and ante-riorpositioning of right arytenoid cartilage (black arrow, C)

  13. Laryngeal Disorders • Laryngeal nerve paralysis • Flaccid VC

  14. Bronchiectasis / CF

  15. Tracheal compression secondary to intrathoracic goiter

  16. Previously Healthy • Episodic wheezing • Progressive exercise intolerance • Bilateral expir wheezes • Treated for asthma • No response

  17. Spirometry • Bronch • 90% blockage distal trachea • Vascular Mass • CTScan

  18. Improved Post-op Spirometry • No symptoms • Free of wheezes InderpalRandhawa, M.D., and Eliezer Nussbaum, M.D. N Engl J Med 2010; 363:e1,July 1, 2010

  19. RUL Bronchus

  20. Foreign Body Aspiration • Initial Xray • Hyperinflation • Very subtle • Which side has the foreign object?

  21. Foreign Body Aspiration Day 3 Nut

  22. Foreign Body Aspiration • I and E

  23. Foreign Body Aspiration FBA

  24. Neuromuscular Bulbar Weakness I < E flow volume Jagged lines (on insp) Inability to perform FIVC

  25. Neuromuscular Bulbar Weakness • Initial visit • Unable to perform FIVC • NIF difficult • 6 mo follow up

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