Wheezing, a high-pitched whistling sound produced during breathing, is among the most common symptoms of asthma. It can occur when you breathe through your mouth or through your nose and when you inhale or exhale—although it’s most common during exhalations.

Wheezing is never normal, but it doesn’t always indicate asthma. It can be a symptom of several other conditions, among them pneumonia, chronic obstructive pulmonary disease (COPD), and certain vocal cord problems.Wheezing is often the reason people seek care.

What Causes Wheezing?

Wheezing is a sign of bronchoconstriction, a narrowing of the airways of the lungs (the bronchi) that impedes the flow of air to and from the lungs, creating a whistling noise during breathing. Again, it’s most common when you breathe out, but can also occur when you breathe in, which may indicate especially advanced asthma.

Bronchoconstriction that occurs in asthma is the result of an inflammatory response to a trigger such as pollen, smoke, or an infection. Triggers differ among people with asthma but in all cases they cause inflammation and tightening of the airways.

In addition to wheezing, which is often the first sign of asthma or an impending asthma attack, there are other classic symptoms of asthma:

  • Chronic cough (especially at night)
  • Chest tightness
  • Dyspnea (shortness of breath)

Treatment

There is no direct treatment for wheezing associated with asthma. However, when it occurs as an early symptom of undiagnosed asthma or an impending asthma attack, it can be stopped along with any other symptoms that are occurring, typically with a rescue inhaler—a device that contains medicine that is delivered directly into the airways and lungs by breathing it in through the mouth.

The medications typically used in rescue inhalers are called bronchodilators. As the name suggests, they work by dilating (expanding) and relaxing the airways to allow for a free flow of air. Also known as rapid-acting bronchodilators, these drugs include:

  • Albuterol (also called salbutamol)
  • Xopenex HFA (levalbuterol)
  • Terbutaline
  • Atrovent HFA (ipratropium)

There are ways to help prevent an asthma attack and the hallmark wheezing and other symptoms of such an episode. Many people with asthma use what is known as a controller inhaler. The medications used most often in these devices are inhaled corticosteriods (ICSs) and long-acting beta agonists (LABAs).

Most people who use an ICS to control asthma do so on a daily basis, often taking several puffs per day, following a healthcare provider-prescribed, regimented schedule.

You also can help to head off wheezing and other symptoms by avoiding the triggers that cause your asthma flares. Clearly, for this strategy to be effective, you need to identify what your triggers are. For indoor triggers such as mold, dust mites, and pet dander, the NIH recommends using a “multicomponent intervention” based on the specific allergen. Again, your healthcare provider can help you fine-tune any measures you may be taking to mitigate indoor allergens.

According to updated recommendations from the National Institutes of Health (NIH) for asthma management issued in December 2020, some people with mild persistent asthma may not need to use an inhaler every day but can instead use an ICS intermittently. If you use an ICS every day to control asthma, ask your healthcare provider if the new NIH guidelines might affect your treatment.

When to Call the Healthcare Provider

Because wheezing is never normal, contact your healthcare provider or go to the emergency room if:

  • Wheezing is newWheezing is not new, but getting worseYou have any other symptoms, such as a change in skin color or you do not seem to be thinking clearlyWheezing occurs after taking a new medication, you are bitten by an insect, or seems to have been caused by something you’ve eaten

If you are already being treated for asthma and you are still wheezing significantly, your asthma action plan may not be working as well as it should or you aren’t following it correctly. When your asthma is well controlled, you should not experience wheezing. In many cases, tweaking a prescription may be all it takes to keep asthma symptoms such as wheezing at bay.