Can tracheitis present with wheezing?

Tracheitis Can Present with Wheezing

Yes, tracheitis can present with wheezing, particularly when inflammation causes narrowing of the tracheal lumen, leading to turbulent airflow during respiration. 1

Clinical Presentation of Tracheitis

Tracheitis presents with a constellation of symptoms that may include:

• Wheezing due to airway narrowing and turbulent airflow through the inflamed trachea 1
• Stridor, which is often more prominent than wheezing in severe cases 2, 3
• Cough, which may be persistent and unresponsive to typical asthma treatments 1
• Fever, though notably 60% of patients may be afebrile at presentation 3
• Respiratory distress with increased work of breathing 2
• Dyspnea that progressively worsens 2
• Purulent secretions in the trachea, especially in bacterial tracheitis 4, 5

Types of Tracheitis and Their Presentation

Bacterial Tracheitis

• Characterized by copious thick purulent tracheal secretions 5
• Often follows a viral upper respiratory infection 4
• Common pathogens include Staphylococcus aureus and Haemophilus influenzae 4, 5
• May present with stridor and wheezing that does not respond to nebulized epinephrine or corticosteroids 2, 3
• Can rapidly progress to severe respiratory distress requiring intubation 2, 6

Viral Tracheitis

• May present with milder symptoms compared to bacterial tracheitis 3
• Wheezing may be more prominent than in other upper airway infections 1
• Often precedes bacterial tracheitis as the primary infection 4

Differential Diagnosis When Wheezing is Present

When wheezing is the predominant symptom, tracheitis may be misdiagnosed as:

• Asthma - particularly when wheezing is responsive to bronchodilators 1
• Tracheopathia osteoplastica - often misdiagnosed as asthma due to chronic cough and wheezing 1
• Tracheobronchial amyloidosis - frequently misdiagnosed as asthma when wheezing is present 1
• Tracheobronchomegaly - may present with obstructive symptoms including wheezing 1
• Airway stenosis - can cause upper airway wheezing 1

Diagnostic Approach for Suspected Tracheitis with Wheezing

• Evaluate for poor response to typical asthma treatments, which should raise suspicion for tracheitis 1, 2
• Assess for fever and toxic appearance, though these may be absent in up to 60% of cases 3
• Consider radiographic imaging, which may show tracheal narrowing (steeple sign) 2
• Bronchoscopy is definitive for diagnosis, revealing inflammation and possibly purulent secretions or membranes 3, 6

Management Implications

• Bacterial tracheitis with wheezing requires aggressive treatment with antibiotics 2, 4
• Patients may require intubation if respiratory distress worsens, particularly younger children 2, 3
• Poor response to nebulized epinephrine or corticosteroids should increase suspicion for bacterial tracheitis 2
• Frequent airway clearance may be necessary to prevent obstruction from secretions 5

Clinical Pitfalls to Avoid

• Misdiagnosing tracheitis as asthma when wheezing is present, leading to inappropriate treatment 1
• Failing to recognize the potential for rapid deterioration, particularly in bacterial tracheitis 2, 5
• Overlooking tracheitis in patients who are afebrile or not appearing toxic 3
• Continuing bronchodilator therapy without considering antibiotics when there is poor response 2, 4