Clinical Features

Wheezing is not synonymous with airflow obstruction, and it must be remembered that

1. Wheezing can occur in normal adults and children without evidence of airflow limitation during quiet inspiration.

2. Forced expiration can produce wheezing in normal individuals, rendering its presence diagnostically useless.

3. Patients with obstruction may not have wheezing; the sensitivity of wheezing in detecting bronchial hyperreactivity with airflow limitation of greater than 20 percent is at best 75 percent, and patients with profound obstruction (<20 percent of normal) may have not enough gas movement to generate a sound.

These facts notwithstanding, wheezing is usually associated with asthma and other obstructive pulmonary diseases characterized by bronchial obstruction due to muscular spasm and inflammation (Table.,..58r3,).

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