Wheezing: causes, red flags and when to seek help

A wheeze is produced when air squeezes through small airways narrowed by muscle tightening, swelling or mucus. It is usually a whistling sound on breathing out, which distinguishes it from stridor, the harsh noise on breathing in that comes from the upper airway. Wheeze may be audible across a room, or only heard through a stethoscope. Some people feel tightness without any audible sound.

Not every noisy breath is wheeze. Rattly breathing from mucus in the chest, a snore, and the crackling sounds of lung infection all differ. A useful clue to the cause is the company the wheeze keeps: cough, breathlessness, fever, rash, heartburn or ankle swelling each point somewhere different.

The NHS describes asthma as a common condition affecting breathing whose symptoms are wheezing, coughing, shortness of breath and chest tightness, which usually come and go and may be worse at night and early in the morning. They can be triggered by exercise, high levels of air pollution, cold air or contact with something you are allergic to, such as pollen, dust, mould or animals. It usually starts in children but can happen at any age.

The NHS says COPD is a group of lung conditions that cause breathing difficulties, including emphysema and chronic bronchitis, mainly affects middle-aged or older adults who smoke, and gets gradually worse over time, and says to see a GP if you have persistent symptoms, particularly over 35 and smoking or having smoked.

The NHS describes bronchiolitis as a common chest infection affecting babies and children under 2, usually mild and treatable at home but sometimes serious. It begins like a cold with sneezing, a runny or blocked nose and a slightly high temperature, then may include a cough, breathing more quickly, difficulty feeding or eating, noisy breathing (wheezing or crackling sounds) and irritability. Symptoms are usually worst between days 3 and 5 and the cough usually gets better in 3 weeks.

The NHS says to call 999 if a child with bronchiolitis has difficulty breathing, with grunting noises, the tummy sucking under the ribs or fast breathing, if there are pauses when they breathe, if the skin, tongue or lips are blue or grey, or if the child is floppy and will not wake up or stay awake. It says to ask for an urgent GP appointment or call 111 if a cold is getting worse, feeding is much reduced, there has been a dry nappy for 12 hours or more, the temperature is very high or low, or you are worried.

For an asthma attack, the NHS says to sit up straight, try to stay calm and use a reliever inhaler if you have one. It says that with a blue reliever inhaler you take 1 puff every 30 to 60 seconds until you feel better, up to a maximum of 10 puffs, shaking the inhaler between puffs and using a spacer if you have one, and that with an AIR or MART inhaler it is 1 puff every 1 to 3 minutes up to a maximum of 6 puffs, or whatever maximum your personal action plan sets. It says to call 999 if you start to feel worse at any time, do not feel better after the maximum dose, or do not have an inhaler, and that if symptoms are no better after 10 minutes and an ambulance has not arrived you can use the inhaler again up to the same maximum dose.

The NHS anaphylaxis page says to call 999 if the lips, mouth, throat or tongue suddenly become swollen, you are breathing very fast or struggling to breathe, you become very wheezy or feel like you are choking, the throat feels tight, skin, tongue or lips turn blue, grey or pale, you suddenly become very confused, drowsy or dizzy, or someone faints and cannot be woken. It advises using an adrenaline auto-injector if you have one.

The NHS heart failure page says to call 999 for severe difficulty breathing, gasping, choking or being unable to get words out, or pale, blue or grey lips or skin, and to ask for an urgent GP appointment or NHS 111 if you feel breathless lying down or from everyday activity, are coughing up frothy pink phlegm or have suddenly gained weight. Sudden wheeze after choking on food or an object also needs 999.

The NHS asthma page says a GP or nurse will ask questions and listen to your chest, and that you may need a simple breathing test, sometimes a blood test, and may be given a peak flow meter to use at home for a few weeks. It says asthma can take time to diagnose because symptoms vary and breathing problems can have different causes, and that if asthma is likely you may be offered asthma medicines to see if they help. For COPD, the NHS says the GP can organise a breathing test to help diagnose it and rule out other lung conditions such as asthma.

Expect questions on when wheeze happens, triggers, smoking, occupation, allergies, family history, hay fever or eczema, night symptoms, medicines and heartburn. Tests may include spirometry, a chest X-ray, blood tests including a full blood count, allergy tests and, if heart failure is suspected, a heart blood marker, ECG and echocardiogram.

The NHS says the main treatment for asthma is medicines breathed in through an inhaler, that a care team supports you with a personal asthma action plan recording how to use medicines, monitor your asthma, avoid triggers and what to do if symptoms get worse, and that you should have check-ups at least once a year including inhaler technique. For COPD it says stopping smoking is the most important thing you can do, with inhalers, pulmonary rehabilitation and medicines also used.

Keep a diary of when wheeze occurs to find triggers, avoid smoke and known allergens, and use inhalers exactly as prescribed. See a GP if you need your reliever more often, or symptoms stop you doing usual activities or wake you at night, as the NHS advises.