Wheeze vs stridor

As with any presenting complains to the GP or the Emergency department, clarification of the complain itself is utmost essential.

When I initially first started off in the ED (emergency department) as a patient complained of a symptom, I didn’t always question it. We sometimes assume our understanding and the patients’ understanding of a symptom is the same. Well, 1 word can mean many things to different people.

A classic example is wheeze. Some people regard any noisy breathing as wheeze. However, noisy breathing can come from a blocked nose, from stridor or it can indeed be a very loud audible wheeze.

Having worked in the Children’s Emergency helps me to appreciate the variety of such cases and train my ears and clinical acumen. For example, a parent presented with noisy breathing and the child was triaged as a wheezing child. Indeed the child was wheezing but he also had a hoarse voice and applied slightly stridorous. When I asked him to cough, there was that characteristic ‘barking cough’. Lo and behold, it was croup. The parents have never come across it before and hence were not familiar with this barking cough.

While on the other end, a baby triaged as wheeze was mainly having a blocked nose.

Hence, moral of the story:

1) clarify the symptoms. if it doesn’t fit the picture, re-think the diagnosis

2) stridor and a hard audible wheeze can sometimes be hard to differentiate

3) always rule out foreign body ingestion

Here are some articles I came across while checking this out: