Wheezing

Wheezing is a whistling sound made when air moves through narrowed airways, usually loudest breathing out. It is the classic sound of asthma — but asthma is not the only cause, and treating all wheeze as asthma is a recognised route to missed diagnoses.

Two things are worth saying plainly at the start.

An asthma attack is an emergency and not something to assess by video. We cannot listen to your chest, measure your oxygen or check your peak flow, and a reassuring conversation while someone is deteriorating is actively dangerous.

A silent chest is worse than a loud wheeze. If wheeze disappears while breathing remains difficult, that means too little air is moving to make the sound. That is a 999 call.

Common

• Asthma — variable wheeze, cough and chest tightness, often worse at night and early morning, triggered by exercise, cold air, allergens or infection
• Viral wheeze, particularly in young children
• COPD — in smokers and ex-smokers, usually over 40, with a more persistent pattern
• Chest infection — bronchitis or pneumonia
• Medication — anti-inflammatories such as ibuprofen and naproxen trigger wheeze in a minority of people with asthma, sometimes severely, and beta blockers can worsen it. See the list on this page
• Allergic reaction

Less common

• Acid reflux — a genuine and frequently missed cause of nocturnal cough and wheeze
• Heart failure — "cardiac wheeze", with breathlessness lying flat and ankle swelling
• Vocal cord dysfunction — noise on breathing in rather than out, often mistaken for asthma and treated with inhalers for years
• Bronchiectasis — with large volumes of daily sputum
• Post-nasal drip

Important to exclude

• Anaphylaxis — wheeze with swelling, rash or collapse. Adrenaline, then 999
• Inhaled foreign body — sudden onset, especially in a child. Often one-sided
• Tumour obstructing an airway — suggested by persistent one-sided wheeze, weight loss or coughing up blood
• Pulmonary embolism

What a consultation covers

• How severe it is right now, and whether you can complete sentences — asked first
• Whether it is new or a known pattern
• Variability — worse at night, early morning, on exertion, or with specific triggers
• One side or both
• How often you need a reliever inhaler, and how many inhalers you get through in a year
• Smoking history
• Your medicines — specifically any anti-inflammatory or beta blocker
• Reflux symptoms
• Ankle swelling and breathlessness lying flat
• Occupational exposures, which are frequently missed

What we may arrange

Full blood count, allergy testing where relevant, and referral for spirometry with reversibility testing and FeNO, which is how asthma is actually diagnosed.

A peak flow diary over two weeks — morning and evening — is genuinely useful and something you can do at home. Variability of more than 20% supports asthma.

The limits of a video consultation — significant here

We cannot listen to your chest, measure your oxygen saturation, check your peak flow, or watch how hard you are working to breathe. Those are the four things that determine how unwell someone with wheeze actually is.

We will not assess an acute asthma attack remotely, and we will not diagnose asthma remotely — diagnosis needs objective testing, and treating breathlessness as asthma without it is how heart failure and other causes get missed.

Where we are useful is continuing established treatment, reviewing control, checking whether a medicine is the culprit, and arranging the right tests.

Is wheezing always asthma?

No, and assuming so causes missed diagnoses. COPD, heart failure, reflux, infection, vocal cord dysfunction and airway obstruction all cause wheeze. New wheeze in an adult who has never had asthma should not simply be labelled asthma.

When is wheezing an emergency?

Unable to speak in full sentences, reliever not working, blue lips, exhaustion, or a silent chest. Call 999. A chest that has gone quiet while breathing is still difficult is worse, not better.

Why will you not assess my asthma attack over video?

Because we cannot listen to your chest, check your oxygen or measure your peak flow — and those determine how unwell you are. A reassuring video call during a deteriorating attack is dangerous.

Can ibuprofen make asthma worse?

Yes, in a minority of people with asthma, sometimes severely. If you have ever wheezed after an anti-inflammatory, avoid the whole class and use paracetamol.

How often should I need my blue inhaler?

Ideally not at all, and no more than twice a week. More than that, or more than three inhalers a year, means the asthma is not controlled.

Do I really need a spacer?

Yes, with a metered-dose inhaler. It substantially increases delivery to the lungs, reduces thrush, and costs very little. It is not just for children.

My child wheezes with every cold.

Viral wheeze is common in young children and most grow out of it. It still needs assessing properly, and any child with severe breathing difficulty, chest sucking in, or difficulty feeding needs emergency care.