Nebulizer

A nebulizer allows medication in the form of breathable mist to persons suffering from respiratory diseases. When a nebulizer is used, the bronchodilator (airway-opening) medication turns into fine droplets that can be administered directly into the lungs. A nebulizer allows the person to absorb the medicines through the mouth. It is particularly useful for those suffering from COPD, asthma and cystic fibrosis.

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.

Bronchodilators

Bronchodilators are respiratory medicines that help in clearing of the airway in the lung muscles. Often the cause of congestion in the lungs is either an inflammation or an infection associated with it. Most of the bronchodilator mechanism of action is on the smooth muscle. Bronchodilators are classified based on their duration of action when administered - long acting and short acting.

Beta 2 agonists

These are administered through inhalers for temporary relief in case of shortness of breath. Their pharmacokinetics is predominantly associated with the movement of cilia inside the lungs to clear the presence of mucus. They are very useful in treating conditions such as asthma. Since their effect is short lived, they are not used in chronic obstructive pulmonary disease.

Anticholinergics

These drugs are similar to beta 2 agonists as they also help in removing the mucous from the channels in the lung tissue. However, the action of this respective drug is longer and hence it becomes an option to treat COPD. In order to administer this drug, a nebulizer is necessary. In the emergency medicine protocol, the drug is used in the form of a mist in the mask following which the patient is asked to inhale the drug.

Theophyllines

These are durable action oriented class of bronchodilators and they are used a lot for COPD. The mode of action of this drug is to limit inflammation by relaxing the lung muscles and air pathways. Increased use of these drugs can trigger side effects such as nausea and light-headedness. These drugs are administered as syrups and they are only recommended in case the patient does not show prophylaxis in case of COPD.

Side effects

Bronchodilators can cause many side effects and their extensive usage can also lead to damage to many organs. Bronchodilators are not recommended in case of medical conditions such as Cardiomyopathy, diabetes and hyperthyroidism as they interfere with metabolic activities of the body sometimes leading to organ failure. This is because bronchodilators also have a tendency to interfere with beta-blockers and cause hindrance in the prophylaxis of tachycardia or hypertension. They also hinder the action of antidepressants in case of conditions such as Alzheimer's disease.