From the Guidelines
Asthma can present with wheezing limited to the upper lobes, although this is not a typical presentation. According to the expert panel report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007 1, asthma is characterized by episodic symptoms of airflow obstruction or airway hyperresponsiveness, and wheezing is one of the key symptom indicators. The report highlights that symptoms of asthma can occur or worsen in various situations, including exercise, viral infections, and exposure to allergens or irritants.
When evaluating a patient with upper lobe wheezing, it is essential to consider other potential causes, such as upper airway obstruction, vocal cord dysfunction, or localized bronchial obstruction from other conditions. The diagnosis of asthma should be established based on a detailed medical history, physical examination, and spirometry to demonstrate obstruction and assess reversibility 1.
Key points to consider in the diagnosis and management of asthma include:
- Episodic symptoms of airflow obstruction or airway hyperresponsiveness
- Airflow obstruction that is at least partially reversible, measured by spirometry
- History of symptoms such as cough, recurrent wheeze, recurrent difficulty in breathing, or recurrent chest tightness
- Symptoms that occur or worsen in the presence of specific triggers, such as exercise or allergens
Management of asthma should follow standard protocols, including the use of bronchodilators like albuterol and anti-inflammatory medications such as inhaled corticosteroids 1. If wheezing remains persistently localized to the upper lobes despite appropriate asthma therapy, further investigation with imaging or bronchoscopy may be warranted to rule out alternative diagnoses.
From the Research
Asthma Presentation
- Asthma is a disease characterized by chronic airway inflammation, leading to intermittent symptoms of wheeze, dyspnea, cough, and chest tightness in combination with variable expiratory airway obstruction 2.
- The diagnosis of asthma is usually established based on the presence of symptoms and documented variability in expiratory airflow limitation as measured by pulmonary function testing 2.
Wheezing in Asthma
- Wheezing is a common symptom of asthma, but it can also be caused by other conditions 3, 4.
- Asthma is often attributed inappropriately to symptoms from other causes, and a careful history, physical examination, and pulmonary function tests are necessary to establish or refute the diagnosis of asthma 3, 4.
Upper Lobe Wheezing
- There is no specific evidence to suggest that asthma typically presents with wheezing limited to the upper lobes 3, 2, 5, 6, 4.
- However, asthma can cause variable airflow obstruction, which can affect any part of the lungs, including the upper lobes 5, 6.
- Other conditions, such as vocal cord dysfunction syndrome or exercise-induced laryngomalacia, can also cause respiratory sounds that may be mischaracterized as wheezing and attributed to asthma 4.