Quick question

[yaf_user681_34383]

When a chest is wheezy isn't it normal to hear wheeze in the upper airway also? Any comments/info would be appreciated.

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you can hear wheeze any where in the chest usually the tops first but would expect to hear it throughout, you only really worry when you cant hear anything !!

g x

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Hi,

It depends what you mean by upper airways really - if you mean the large airways of the chest then yes, you will usually hear wheeze, whether that is due to narrowing of the large airways themselves or transmitted noise from further down.

However, if you are referring to the throat/larynx, that is a bit more contentious. Noise coming from this area is seen by many as a sign that what is going on is something other than asthma - possibly vocal cord dysfunction (VCD - where the vocal cords move abnormally and partially obstruct the upper airway) or laryngeal hyper-responsiveness (where the throat is hyperresponsive to irritants and goes into spasm easily - often coexists with VCD). Anaphylaxis with swelling in the throat can also produce a distinctive noise from this area which is referred to as stidor and does sound different from a wheeze.

However, some consultants do feel differently about this - I can remember Prof Ayres, back when he was at Heartlands, saying that twitchy lower airways often went with twitchy upper airways, and I believe at the time he considered it part of the normal spectrum of asthmatic phenomena. I can't remember him commenting on any specific treatments for it, other than the usual anti-asthma treatments.

I know that when I have an attack I do occasionally get a tight feeling and noise in my throat as well, usually when the attack is induced by an irritant such as smoke or chemical fumes. Excessively dry environments can do it as well. In the past consultants have queried vocal cord dysfunction, as they tend to (quite rightly) in most people who aren't responding very well to normal asthma treatments. However, they have to some extent ruled it out in me by looking at my cords (which they do as part of the Difficult Asthma Protocol at RBH) and by looking at gases, ventilator pressures etc from my acute attacks.

It is worth considering these diagnoses in someone with uncontrolled asthma who has throat symptoms, as vocal cord dysfunction can often be relatively easily managed with training by a speech therapist or physio to try to teach the person how to avoid the abnormal vocal cord movements. Obviously anything that can make the symptoms and acute attacks better without resorting to more medication is a good thing!

The whole interrelation between asthma, VCD and laryngeal hyperresponsiveness is by no means clear, and there is on-going work to try to tease apart the different components. There has been work by several people, including Prof Ayres, to suggest that all three may be functions of an abnormal autonomic nervous system (the automatic part of the nervous system that controls functions such as heart rate, blood pressure and airway width). The whole thing is extremely complex, although fascinating, and I can't claim to understand it fully!

Hmmmm, strikes me that that was an over-complex answer to a seemingly simple question, sorry! I guess nothing is really simple in the world of difficult asthma, though.

Hope this helps rather than confuses!

Em H

[yaf_user681_34383]

Tankyou for taking the time to reply. I was confused because different doctors tell me different things. My laryncoscopy was normal yet my consultant says its not asthma having wheeze in your throat even though i have widespread wheeze elsewhere. My other consultant thinks its part of my asthma as nebs/mg/amin/steroids given help and i don't hyperventilate. So i don't know who to believe. My thrat doesn't get tight and breathing excercises don't help. I wish Doctors would agree with each other.

sadwheezer

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I agree, it does make things confusing when different doctors say different things. It can be hard to know who to believe.

I think it can be an extremely difficult one, even for doctors with many years of experience in the field, which is why, I think, RBH always query VCD with anyone with difficult asthma as part of their Difficult Asthma Protocol. A normal laryngoscopy doesn't rule it out entirely, either, as the abnormal movement of the vocal cords is often only seen when the patient is exposed to a stimulus such as a perfume. Even then, when attempts are made to replicate this stimulus as part of the test, it may be negative despite the patient having VCD.

That might help you to understand why doctors might still query this diagnosis with a normal laryngoscopy. I would have thought, though, (and this is only my opinion, which I hestitate to add given that you already seem to have had several opinions!) that the presence of wheeze throughout your chest and a good response to the usual asthma medications would suggest that asthma is the main problem. However, VCD can and does often co-exist with asthma.

Hope this sheds a little light on why the doctors don't seem to be able to make up their minds!

Em H