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Wheezing

Wheezing is a characteristic high pitched whistling sound made while breathing, a primary symptom of a chronic respiratory disease - Asthma. It is not uncommon in those with respiratory allergies, especially during the hay fever season. Sometimes, other respiratory infections could be accompanied by mild wheezing, especially when acute Bronchitis is experienced. It is also noticed in those with heart failure and Chronic Obstructive Pulmonary Disease COPD. While most commonly wheezing occurs during breathing out, it can sometimes also be related to breathing in.


Causes of Wheezing

Narrowing of airways results in breathing difficulty and wheezing. There could be several causes for narrowing of airways including inflammation from asthma, infection, allergic reaction or a physical obstruction such as tumor or foreign body inhalation. Among the possible causes of wheezing include allergies, insect bite or medication or pollen, pet dander, dust, foods, Bronchiolitis, bronchitis, childhood asthma, epiglottitis, GERD, heart failure, lung cancer, pneumonia, sleep apnea, smoking and vocal cord dysfunction.


Respiratory Syncytial Virus (RSV) Infection is also known as Bronchiolitis - inflammation of the bronchioles which in turn refer to the the narrow airways which branch from bronchi to the air sacs called as alveoli. This RSV infection largely affects infants and children.

To determine the cause of wheezing, your doctor will ask questions about any symptoms that triggers it. If you have no history of lung disease and develop wheezing after eating a certain food or in a certain season, respiratory allergy is suspected. The doctor checks the lungs with a stethoscope to find out where the wheezing is and how bad it is. During a first time evaluation, the doctor performs a spirometry - breathing test, and also a chest X ray.

Sometimes other blood tests and procedures become necessary depending upon the health condition. In case it is allergic wheezing, then a variety of tests to determine the allergies including dermatological examinations are done.


Wheezing problems

Wheezing is accompanied by difficult breathing, rapid breathing and briefly bluish skin color. Emergency care must be sought if wheezing begins suddenly after being stung by a bee, while taking medication, or eating an allergy-causing food or after choking on a small object or food.


Wheezing in infants

In case of a baby, wheezing could be due to cold or problematic asthma. But it is not always clear if the infant has asthma. It is essential to get a firm diagnosis and make sure that the child gets treated for any breathing problems. In some infants, Bronchiolitis could occur due to a viral infection. The airways swell making breathing difficult. As the airway of an infant is small, infants are easily affected. Wheezing could result due to Bronchiolitis, which may develop into asthma in later life. Otherwise a child could be born with a tendency to wheeze and therefore could be prone to bronchiolitis and asthma. Less common reasons for wheezing in infants include inhalation of a foreign object or piece of food into the lungs, premature birth, insufficiently developed airways and cystic fibrosis.


Treatment options

A variety of treatments are available to help alleviate wheezing. However, regular monitoring by a doctor is a must, especially if the patient has asthma, chronic allergies, severe bronchitis, emphysema or chronic obstructive pulmonary disease. In some, wheezing can be relieved by certain medications or by using an inhaler. Some might need insertion of a breathing tube into the throat. The doctor may recommend some or all of the following to reduce inflammation and open up the airways obstructing breathing to stop wheezing:


  • A bronchodilator inhaler, which can act fast to dilate constricted airways.
  • An inhaled Corticosteroid
  • A long-acting bronchodilator and Corticosteroid combination
  • A controller pill for asthma to reduce airway inflammation
  • A non-sedating antihistamine pill or a prescription nasal spray for nasal allergies, which are available over the counter.

Self-care measures to ease wheezing

Moisturize the air by either using a humidifier or a steamy shower or just sit in the bathroom with the door closed while running a hot shower. This is simply because moist air can help relieve mild wheezing in some cases.

Drinking fluids can relax the airway and loosen up sticky mucus in the throat.

Active or passive smoking can worsen a cough and hence it is best to avoid tobacco.


Emergency

Normally, mild wheezing that accompanies bronchitis disappears when the infection subsides. But in case of breathing difficulty, she needs to rush to the doctor who can administer the following:


  • A shot of epinephrine to open up the clogged respiratory passages.
  • Oxygen
  • Frequent nebulizer to ease breathing
  • A mechanical ventilator to help you breathe

It is for the doctor to determine the cause of wheezing and then treat the patient for the specific cause.


Otolaryngologist

Also known as otorhinolaryngolongists or ENT specialists, otolaryngolongists are doctors who specialize in diagnosing and treating disorders of the ear, nose and throat. After completing medical school, a one year residency in general surgery is compulsory further followed by four years of residency in otolaryngology. Being specialists in the ENT organs, otolaryngolongists perform the following functions:


  • Primarily treat disorders related to ear, nose, and throat.
  • Treat conditions like sinus and problems with nasal cavities by either prescribing medicines or performing surgery.
  • They treat allergies and help improve the shape and look of the nose (rhinoplasty).
  • They treat hearing problems, ear infections, balance disorders of the ears, tinnitus (ear noise), cranial nerve disorder etc.
  • They treat conditions like sleep apnea.
  • They cure tonsils either through medication or surgery, they treat throat disorders including voice and swallowing disorders.

Modern techniques used in the field of otolaryngology


ENT field has seen a lot of innovations in use of equipment and technology, modern methods have paved avenues for better treatment methods.

  • Modern equipment have paved ways for these specialists to perform reconstructive surgeries for nose, jaw, ear and facial areas.
  • RAST (radio-allergosorbent-test) is used for curing allergies.
  • Technique called the skin endpoint titration is used to cure allergies.
  • Endoscope technique is used to treat sinus and other blockages.
  • Modern audio logic equipment is used to diagnose and treat hearing problems.

Guide to choose the right otolaryngologist


  • Ask your family physician to refer to the right specialist.
  • Check if the specialist you have chosen is certified by an authorized board.
  • Check if the hospital where your specialist practices has the required infrastructure and modern equipment needed for your treatment.


Sedatives

Antihistamines

Antihistamines are widely used for allergies and motion sickness. As they exhibit properties that can indirectly induce drowsiness, there is a class of antihistamines, sold as OTC sleeping pills. However, the American Academy of Sleep Medicine warns that such pills should be used only occasionally. Beware that there is a price to pay for buying OTC antihistamines. Some OTC sedatives combine antihistamines with pain relievers and some combine it with alcohol.


They can induce abnormal muscle spasms. Other side effects are blurred vision, constipation, diarrhea, nausea and vomiting, dry mouth and general dehydration. Therefore she needs to consume plenty of water if she is taking any antihistamine. In elders and children, antihistamines can cause nervousness and insomnia. Similarly, asthmatics should steer clear of antihistamines as these can aggravate their condition. They can affect the behavior of the fetus in the womb. Antihistamines also interfere with lactation. Be warned that OTC antihistamines should never be clubbed with alcohol or other sedatives.


Although it is construed that some antihistamines are non prescription sleep aids, and they are more sedating than prescription hypnotics, beware that their effectiveness may decrease over time. More importantly, OTC sedative is only meant for short-term insomnia and by and large the long term effectiveness and safety of the OTC drugs is questionable. However, for transient insomnia or insomnia based on illness or depression, antihistamines can be an effective OTC tool.


Sedative antihistamine list includes (the following list also contains suggested dosage for an adult. Always take the medications e.m.p (ex modo prescripto as directed by the physician):

  • Chlorpheniramine (Chlor-Trimeton) 4 mg every 4 to 6 hrs; maximum dose: 24 mg/day

  • Cyproheptadine (Periactin) , 4 mg at bedtime

  • Clemastine (Tavist), 50-100 mg every 4-6 hours, not to exceed 400 mg/day and it is supplied in table form chewable

  • Diphenhydramine (Benadryl), as a night sleep aid to be taken 30 minutes before bedtime, and the dosage is 50 mg for adults

  • Promethazine (Phenergan) Sedation: 25-50 mg orally or 50 mg rectally

  • Hydroxyzine (Atarax, Vistaril), oral sedation dosage 50-100 mg, IM 25-100 mg. Intravenous (IV), subcutaneous and intra-arterial administrations are not recommended as these can cause thrombosis and digital gangrene.


These come in various brand and trade names and they can be taken as tablets, syrups or nasal sprays. Droplet form for use in the eyes is also available. The effects of these antihistamines including drowsiness, dizziness, headache, loss of appetite, vision changes, irritability, dry mouth, stomach upset should subside, when the body begins to adjust with the medication. If these side effects continue, it is better to contact the medical practitioner. Sedative antihistamines may be taken with food and milk. Sustained release low acting tablets can be swallowed whole as chewing the sustained release long acting tablets may destroy the action and increase the side effects. Chewable tablets can be chewed thoroughly and swallowed. Suspensions should be shaken before food consumption.


Melatonin

This is a hormone produced by human body – by the pineal gland, a pea-sized structure at the center of the brain. This regulates sleep and wakefulness. Taken as a supplement, melatonin helps to reduce delayed sleep syndrome. This also improves sleep quality and lengthens the period of sleep. Day time alertness also seems to improve when this is taken. Melatonin can treat insomnia without altering the sleep pattern of the individual. It also does not impair any performance related skills.


This may help elders with insomnia as the amount of melatonin produced in the body seems to decrease as one gets older, although it is not recommended for chronic insomnia. Melatonin works on the circadian rhythm – the biological clock that regulates our sleep and wake cycles. Many become melatonin deficient due to age, work schedules and stress. Melatonin supplements are a quick way to adjust the lack of melatonin in the body and rebalance the sleep cycle. These are available OTC and when used in conjunction with herbs like chamomile and lemon balm, help lull the body to sleep acting as a true sedative.

Although Melatonin shows good effects for the treatment of insomnia, if used in excess, this sedative can produce side effects including sexual irregularities, mood swings and depression. Although by and large safe when used in moderation, it is unsafe for small children and pregnant women to use melatonin supplements. It is also not recommended for those with lymphoma, extreme allergies, depression, rheumatoid arthritis, auto immune diseases and for cancer patients. Some melatonin sedatives include:

  • clonazepam (Klonopin)

  • lorazepam (Ativan)

  • phenobarbital (Donnatal)

  • zolpidem (Ambien)


As such Melatonin can cause sleepiness and drowsiness, and if taken with sedatives that cause sleepiness, then too much of sleepiness can result. Research indicates that quick release Melatonin can be more effective than sustained-release formulations, especially when used as sedatives. Intramuscular injections of 20 mg of Melatonin are also available.


SAMe

This is also found naturally in the body. This OTC aid can not only help to sleep but also treats depression and chronic fatigue by promoting serotonin production in the body. Unless consumed in large quantities, SAMe has no known side effects.


Antidepressants used as sedatives

Although the FDA has not approved the use of antidepressants as sedatives, there are those who believe that insomnia is related to depression. As with any other medication for depression, there is a significant risk of suicidal thoughts particularly in adolescents and children. Approximate dosage of antidepressants s.o.s (si opus sit only if there is a need) :

Citalopram 20 mg
Escitalopram 5-10 mg
Fluvoxamine 100 mg
Fluoxetine 20 mg
Paroxetine 20 mg
Sertraline 50-75 mg
Venlafaxine 75 mg
Donormyl sleeping pills are available without prescription and they are approved by the FDA for non-prescription. They are used in the treatment of insomnia. 25 mg of Donormyl is the strongest non-prescription sleeping pill. Possible common side effects of antidepressant sedatives include diarrhea, dizziness, headache, insomnia, rash, vomiting, blurred vision, decreased appetite, cold symptoms, nervousness, cramps, hallucinations, hair loss and decreased coordination.


OTC sedatives side effects

Although OTC sedatives can be effective for an occasional sleepless night, the longer you take them, the less they are likely to make you sleepy. OTC sleep aids can leave you feeling groggy and unwell the next day. This is like the 'hangover' effect. Much remains unknown about the safety and effectiveness of OTC sleep aids.

Dizziness and forgetfulness, clumsiness, feeling off balance, dry mouth and throat are some common side effects. Serious risks of OTC sedatives include severe allergic reaction, facial swelling, memory lapses, hallucinations, suicidal tendencies, sleep-related complexities such as sleep-walking, sleep-driving, and sleep-eating. If any unusual sleep-related behavior is exhibited, consult the doctor immediately.


Over-the-counter sedative tips


  • Consult the doctor before taking OTC sedative, although you do not need the doctor concurrence to buy an OTC drug. This is because your doctor can make sure that the sedative does not interfere with other underlying medications.
  • Certain OTC drugs are not recommended for those with glaucoma, asthma, chronic pulmonary disorders, liver diseases and urinary retention.
  • Remember that OTC sedatives are only a temporary solution for insomnia and they are not intended to be used for longer than about two weeks.
  • Persistent insomnia is a symptom of an underlying medical or psychological problem. These cannot be cured with OTC sedatives. It is better to learn about safer and effective way of end sleepless nights.
  • Never mix alcohol with sedatives and this can increase the sedative effects of the medication.
  • Combining medications such as OTC sedatives and pain relievers and allergy medicines is very dangerous.
  • Do not drive or attempt any other activity that may require alertness while taking a sedative.
  • Over a period of time, you may build up intolerance to sedatives and this can in turn lead to more side effects.
  • You may also come to rely on sedatives and will be unable to sleep without them.

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Collection of Pages - Last revised Date: November 21, 2017