TürkçeWheezing is a condition in which a whistle-like sound is heard from the lungs while breathing in and out as a result of narrowing or obstruction of the airways. This sound usually occurs due to narrowing of the bronchi and is considered a clinical indicator of a functional disorder in the respiratory system.
The causes of wheezing primarily include asthma, bronchitis, COPD, and allergic reactions. Infections, foreign body aspiration, and smoking may also narrow the airway lumen and lead to a similar condition. Correct identification of the underlying pathology is important for treatment planning.
Symptoms of a whistling sound coming from the lungs are usually accompanied by shortness of breath, a feeling of tightness in the chest, and coughing. During physical examination, a wheezing sound is heard through auscultation. In severe cases, a decrease in oxygen saturation may be observed, and urgent medical evaluation may be required.
The treatment of wheezing is arranged according to the underlying cause, and bronchodilator medications form the basic approach. Corticosteroids and oxygen support are administered when necessary. In chronic diseases, regular follow-up, avoidance of triggers, and patient education provide clinical control.
Is Wheezing Always a Sign of Asthma?
When a patient enters the outpatient clinic with a whistling sound coming from the chest, the first diagnosis that usually comes to mind is asthma or chronic bronchitis (COPD). This is very natural because these are the most common causes we encounter in society. In asthma, the airways contract, narrow, and relax again with medication. However, our perspective as surgeons is slightly different. If a patient does not improve despite regularly using asthma medications, if shortness of breath increases day by day, or if the wheezing is heard not only while breathing in (inspiration) but also while breathing out in a very pronounced and “fixed” tone, alarm bells ring for us.
Here, we suspect what we call “mechanical obstruction,” meaning a blockage that physically obstructs the airway. This obstruction may be a piece of tissue growing inside the trachea, a lymph node pressing from the outside, narrowing caused by a previous disease, or a foreign body that has entered the airway. Therefore, not every wheeze is asthma; sometimes it is a sign of an anatomical blockage that needs to be surgically corrected.
At this point, some critical symptoms suggesting causes other than asthma are as follows:
- Sudden-onset wheezing
- Fever
- Bloody sputum
- Weight loss
- Difficulty swallowing
- Swelling in the neck area
- Shortness of breath that changes with position
Which Clues Do We Follow When Making a Diagnosis?
The path to the correct treatment begins with listening to the patient very carefully. Sometimes a tiny detail described by the patient leads us to the result faster than the most complex imaging devices. For example, when the wheezing began is a vital question. In an adult who says, “Doctor, I suddenly had a coughing fit while eating, and I have had wheezing ever since,” foreign body aspiration immediately comes to mind.
During the physical examination, the “musicality” of the sound we hear when we place the stethoscope on your chest guides us. If the sound we hear is “polyphonic,” meaning multi-toned, with different sounds like an orchestra, this usually indicates conditions affecting the lungs in general, such as asthma. However, if the sound we hear is “monophonic,” meaning a fixed and persistent whistle coming from a single note, it tells us: “There is a fixed obstruction at a certain point in the main airways; focus there.”
At the same time, we map this obstruction with Pulmonary Function Tests (PFT). PFT does not only measure your breathing capacity; it also shows us with graphs where the obstruction is located in the airway (at the entrance or deeper inside) and what type of narrowing it is (fixed or variable).
Some parameters we pay attention to in PFT results are as follows:
- Forced expiratory volume (FEV1)
- Lung capacity (FVC)
- Breathing flow rate
- Shape of the flow-volume curve
Can Benign Tumors in the Lung Cause Wheezing?
The word “tumor” understandably frightens everyone. However, not every mass we see in the lungs and airways is cancer. Benign tumors do not spread to other parts of the body and do not gradually consume you from within; however, due to their location, they create a strategic problem. A benign tumor located inside the trachea or main bronchi behaves like a pebble stuck inside a garden hose. It disrupts the flow of water (air), causes pooling (infection) behind it, and makes the hose vibrate (wheezing).
In particular, masses called “Hamartomas” are the most common benign guests of the lung. They are usually composed of cartilage and fatty tissue. There are also fatty masses called “Lipomas.” Because these grow slowly, the body adapts to them for a while. The patient may use sprays for years, saying, “I have allergic asthma,” but never fully recover. However, the problem is mechanical rather than chemical.
The treatment of these masses is not medication. As long as they remain there, the wheezing does not go away, and worse, the lung tissue behind the blocked area begins to “decay” over time and loses its function. Therefore, even if they are benign, these masses must be removed surgically or by endoscopic methods. With early intervention, the rest of the lung can be completely saved.
The types of benign endobronchial tumors we frequently encounter are as follows:
- Hamartomas
- Lipomas
- Papillomas
- Fibromas
- Chondromas
- Neurogenic tumors
Why Does Shortness of Breath Occur After Intensive Care?
Thanks to modern medicine, we can now survive very severe diseases and traumas. One of the most important life-saving procedures in intensive care units is connecting the patient to a ventilator (intubation) or creating an opening in the throat (tracheostomy). These procedures keep the patient alive at that moment. However, they may sometimes come at a cost during the recovery process.
Tubes placed inside the trachea may impair blood circulation in that area when they remain for a long time or when the cuff is overinflated. During the healing process, just as your skin forms a scab and leaves a scar after a deep cut, the body also creates healing tissue inside the trachea. However, because the trachea is a closed cylindrical tube, this healing tissue grows inward and narrows the airway. We call this “Tracheal Stenosis.”
The patient is discharged from intensive care, goes home, and everything seems fine. However, a few weeks or months later, the patient notices that breathing is insufficient while walking and that a wheezing sound is coming from the throat. It is usually thought, “My lungs have not recovered yet.” However, the problem is not in the lungs but in the main highway that carries air to the lungs. The road has narrowed from three lanes to one lane. This condition severely limits the patient’s exercise capacity and, if left untreated, may progress to a feeling of suffocation.
Is a Surgical Solution Possible for Tracheal Stenosis?
The treatment strategy for tracheal stenosis is determined entirely according to the structure and length of the narrowing and the patient’s overall condition. However, I can say this clearly: If the patient’s overall health condition permits, the most permanent and most successful treatment for this disease is surgery. This operation, which we call “Tracheal Resection and Anastomosis,” is one of the most delicate and technically demanding procedures in thoracic surgery.
The logic is actually simple: We cut out and remove the narrowed, scarred, no longer functional “damaged” part of the trachea. We then join the remaining intact and healthy upper and lower ends together with special sutures (end-to-end anastomosis). Thus, while the patient was trying to breathe through a very narrow straw, the patient suddenly regains an airway of normal width. Seeing the relief on patients’ faces as soon as they wake up from surgery is a priceless moment for us surgeons.
Of course, not every patient may be suitable for surgery. Sometimes the narrowing is too long, and sometimes the patient’s heart or lung capacity cannot tolerate this operation. Temporary solutions then come into play. However, in a patient who has a chance of surgery, our first goal should always be to completely eliminate that narrowing.
The examinations performed during preparation for surgery are as follows:
- Neck and chest tomography
- Rigid bronchoscopy
- Cardiological evaluation
- Blood gas analysis
Should the Entire Lung Be Removed in Cancer-Related Obstructions?
Malignant diseases such as lung cancer or carcinoid tumors sometimes settle in the main airway or at the entrances of the lobes, causing severe wheezing and obstruction. In the past, the surgical approach was more radical; it was said, “The tumor is in the main center, so let us remove the entire lung on that side (pneumonectomy).” Yes, this removed the tumor, but it condemned the patient to living with one lung. It is possible to live with one lung, but quality of life and exercise capacity decrease significantly.
Today, however, as thoracic surgeons, we adopt the philosophy of “parenchyma-sparing surgery.” Our aim is not only to remove the cancer but also to leave behind as much healthy lung tissue as possible. This is where the operation we call “Sleeve Lobectomy,” or “Sleeve Resection,” comes into play.
Let us compare it to the sleeve of a shirt. There is a stain (tumor) on the elbow section of the sleeve. In the past, we threw away the entire shirt. Now, we cut out only the stained elbow section and bring the wrist section up and sew it back to the shoulder section. In other words, we remove only the diseased vessel and airway section and reconnect the remaining healthy lobes of the lung to the main airway. In this way, while the patient is freed from cancer, a large part of the lung is also preserved. This is a technically demanding operation, but the result for the patient is tremendous.
Does Foreign Body Aspiration Occur in Adults?
When people hear “swallowing a foreign body” or “something entering the airway,” everyone thinks of crawling babies or young children playing. However, adults are not as innocent or safe in this regard as you may think. In particular, the rush and carelessness brought by modern life or certain medical conditions also expose adults to this risk.
The most common scenarios we see in adults are accidental aspiration of materials used during dental treatments, trying to speak while holding a headscarf pin in the mouth, or food entering the wrong passage as a result of laughing or talking while eating quickly. Sometimes alcohol consumption or sedative medications slow down the protective reflexes in our throat and facilitate aspiration. Some people who suddenly become ill while eating in a restaurant and are thought to be having a heart attack, a condition we call “Cafe Coronary,” are actually suffocating because a large piece of meat has blocked the airway.
The condition in adults is somewhat more insidious. Initially, there is a coughing fit, then the object settles in a corner and the patient feels relieved. Days later, they present with “persistent pneumonia,” “stubborn wheezing,” or “blood in the sputum.” The patient may have forgotten the initial coughing fit. Our duty is to always keep this possibility in mind.
Objects frequently aspirated by adults are as follows:
- Dental prostheses
- Dental filling materials
- Headscarf pins
- Chicken bones
- Fish bones
- Nuts
- Tablet medications
In Which Situations Are Airway Stents Used?
Sometimes the patient’s condition is so critical that a major operation cannot be tolerated, or the tumor has spread so extensively that it cannot be completely removed. In such cases, the patient’s ability to “breathe” is more important than anything else. Just like the stents used to open heart vessels, we have special stents (endoprostheses) designed to keep the airway open:
These stents resemble hollow tubes. They are made of silicone, metal, or a combination of both materials (hybrid). Under general anesthesia, they are placed at the site of the narrowing through bronchoscopy. When the stent opens, it pushes the narrowing outward and provides the patient with a wide air tunnel. The patient feels relief as soon as they wake up. However, for us, stents are generally not a “permanent solution” but a “bridge treatment” or “palliative (relieving) treatment.”
Silicone stents are especially preferred because they are more compatible with tissue and can be removed when necessary. However, stents also require maintenance. Because they do not contain ciliated cells that work like a broom, they cannot clear sputum on their own. Therefore, patients with stents need to drink plenty of water, use humidifiers to prevent the sputum from drying, and attend regular follow-up appointments.
The situations in which stent use is preferred are as follows:
- Tumors unsuitable for surgery
- Tracheomalacia (cartilage collapse)
- Tracheoesophageal fistulas
- Masses causing external compression
What Are the Non-Surgical Interventional Methods?
Although incisions and sutures immediately come to mind when thoracic surgery is mentioned, technology also gives us the opportunity to treat patients without making any incision in the body by using the natural airways. In this field, which we call “Interventional Pulmonology,” we can work wonders with various devices passed through the tip of the bronchoscope.
These methods play a vital role, especially in clearing tumors that obstruct the inside of the airway or stopping bleeding. The patient may be discharged on the same day or the next day. These procedures are generally performed through a hard metal tube called a “Rigid Bronchoscope” because this device provides us with a wide working channel.
The main interventional methods we use are as follows:
- Mechanical dilation
- Cryotherapy
- Argon Plasma Coagulation
- Laser ablation
- Electrocautery
- Photodynamic therapy
For example, “Cryotherapy” (freezing treatment) allows us to break down the tumor by freezing it to temperatures as low as -80 degrees. It is especially effective in bleeding masses. Laser or Argon Plasma (APC), on the other hand, opens the airway by burning or vaporizing the tumor with heat energy. We decide which method to use according to the type and location of the tumor.
Can Vascular Anomalies Cause Wheezing in Children?
In the pediatric group, meaning babies and children, persistent wheezing may sometimes be caused by a very interesting condition: “Vascular Ring.” This is a completely congenital anatomical difference. Instead of following their normal route during development in the womb, the main arteries arising from the heart wrap around the trachea and esophagus in the form of a complete or partial ring.
These vessels press on the trachea from the outside. The child makes a wheezing sound while breathing (stridor) and may sometimes have difficulty swallowing because the esophagus is also under pressure. These children often receive antibiotics after being diagnosed with “bronchitis” or “pneumonia,” and asthma medications are prescribed, but they never fully recover. This is because the problem is not microbial but mechanical; the vessel is compressing the trachea.
Once diagnosed, the treatment is surgery. During the operation performed together with the cardiovascular surgery team, the vessel structure causing the compression is rearranged or suspended. Thus, the trachea is freed, and the child’s breathing and feeding return to normal.
How Does the Postoperative Process Proceed?
After thoracic surgery or an interventional procedure, the patient’s greatest partner in the recovery process is still the patient. No matter how successful the operation is, postoperative care and rehabilitation are at least as important as the operation itself.
Our greatest request from our patients is “Respiratory Physiotherapy.” The lungs do not like inactivity. Avoiding breathing due to fear of postoperative pain causes the lung to collapse (atelectasis) and sputum to accumulate. Therefore, we give our patients breathing exercise devices called “Triflo,” which contain balls, and ask them to use them continuously. In addition, “coughing” is not prohibited in our ward; on the contrary, it is encouraged. Controlled and strong coughing is the most natural medicine for clearing the lungs.
In patients who have undergone tracheal surgery, we pay attention to neck position. To prevent tension on the suture line, we ask the patient to keep the head tilted forward for a while. This is a critical one-week period for the sutures to heal safely.
The points to pay attention to after surgery are as follows:
- Deep breathing exercises
- Use of Triflo
- Drinking plenty of fluids
- Early mobilization
- Strict avoidance of smoking
Frequently Asked Questions
Prof. Dr. Alper Fındıkcıoğlu graduated from Istanbul University Faculty of Medicine and completed his thoracic surgery residency at Dr. Siyami Ersek Hospital. He began his academic career at Başkent University in 2005; he received the title of associate professor in 2014 and professor in 2022. He has extensive experience in lung cancer, chest wall diseases, and minimally invasive surgery. Since 2024, he has been continuing his professional work at Acıbadem Hospital.
