14 causes of wheezing—and how to treat it

Have you ever heard a whistling or rattling sound when you breathe? It could be wheezing, a sign that you’re having difficulty getting air out of your lungs. Wheezing most often occurs when the small airways in the lungs (called bronchial tubes, or bronchioles) become blocked, constricted, or inflamed. Wheezing can happen because of respiratory conditions like asthma or pneumonia. But it can also be due to things like heart conditions, digestive issues, and even stress.

Wheezing is common and has many causes. In one study of adults aged 20-44, roughly 20% reported wheezing in the last year. Notably, babies, with their smaller airways, are particularly prone. In fact, nearly 30% of babies will develop wheezing by a year of age. Some wheezing resolves without treatment. But chronic or serious cases need medical treatment. Here, what you need to know to breathe easier.

What does wheezing feel like?

Wheezing is a shrill or high-pitched whistling sound made on inspiration or exhalation; however, it is much more common to occur with exhalation. This is called expiratory wheezing. When you wheeze, your chest may feel tight and breathing can be difficult. It feels like:

Shortness of breath
Inability to breathe out fully
Rapid, shallow breathing

What causes wheezing?

Wheezing usually occurs when the air tubes in the lungs are inflamed. It can also occur when the muscles around the airways tighten, causing the airways to narrow. “When a healthcare professional thinks of wheezing, they think of sounds coming from the lungs,” says Gabriel Neal, MD, a clinical associate professor at Texas A&M University College of Medicine. “And that’s generally only heard with a stethoscope.”

While wheezing-like sounds can emanate from the upper airways (like the nose or throat), the noise is most likely “congestion, snoring, or stridor,” says Jessica Hui, MD, an allergy and immunology physician at National Jewish Health in Denver. Stridor is a high-pitched but less musical sound than a wheeze and can result from viral infections like the croup.

It’s unlikely that upper airway issues, such as post-nasal drip, sleep apnea (a sleep disorder where breathing stops and starts), or even allergies will result in wheezing. Ditto for vocal cord dysfunction, which occurs when the vocal cords shut when they should be open. Vocal cord dysfunction can occur due to viral infections, anxiety, or cigarette smoke, making it hard to get air into the lungs.

“Patients can usually decipher if the discomfort or noisy breathing is coming from the throat or in

the chest,” Dr. Hui adds. “But if it’s a noise you’re able to hear, it’s more likely to be from the throat or upper airway, and not the lungs.”

Some of the most common causes of wheezing are:

Asthma
Acute bronchitis
COPD
Reactive airway disease
COVID-19
Pneumonia
Bronchitis
Lung cancer
Cystic fibrosis
Congestive heart failure
GERD
Smoking
Stress
Foreign object

Respiratory causes

1. Asthma

Asthma is a chronic lung condition in which the lungs respond to certain triggers, such as exercise, smoke, allergies, or respiratory infections like the common cold, with swelling and wheezing. Other symptoms can include cough and chest tightness. Nearly 50% of people with asthma report wheezing as a symptom. If you experience wheezing at night, it could be a sign your asthma is not well-controlled.

2. Acute bronchitis

Acute bronchitis is a viral infection that inflames the bronchial tubes, which are the tubes that move air in and out of your lungs. In addition to wheezing, bronchitis can cause increased phlegm, chest tightness, a cough, fever, and chills. Unlike chronic bronchitis, which is long lasting, acute bronchitis generally comes on suddenly and runs its course in a few days to a couple of weeks.

3. Chronic obstructive pulmonary disease (COPD)

COPD is a group of progressively worsening lung diseases that includes chronic bronchitis and emphysema. COPD occurs when the tiny air sacs—called alveoli—that sit at the bottom of the bronchial tubes are destroyed and do not work well to exchange oxygen. Smoking cigarettes and other tobacco products causes 90% of COPD.

4. Reactive airway disease

This is a medical condition similar to asthma. Sometimes, the body overreacts to a trigger (common ones include infections, allergens, cold air, and chemicals) causing swelling in the airways and an increase in mucus production. It can also cause the muscles around the airways to contract.

5. COVID-19

COVID-19 is a viral infection that often affects the lungs; it causes airway inflammation and labored breathing.

6. Pneumonia

Pneumonia is a viral or bacterial infection affecting the air sacs (alveoli). These air sacs become inflamed, fill with pus or fluid, and lead to breathing problems like wheezing.

7. Bronchiolitis

Bronchiolitis is an infection of the small tubes (bronchioles) in the lungs. The infection produces swelling and mucus buildup, which causes to narrowed airways and wheezing. The most common culprit is a respiratory infection, particularly respiratory syncytial virus (RSV), which is common in babies and young children.

8. Lung cancer

New onset of wheezing is one of the most common symptoms of lung cancer, reports the American Cancer Society.

9. Cystic fibrosis

Wheezing is a common symptom in people with cystic fibrosis, a genetic and progressively worsening lung condition characterized by thick mucus deep in the airways that causes difficulty breathing.

Heart issues

10. Congestive heart failure

Congestive heart failure (also called CHF or heart failure) occurs when the weakened or damaged heart doesn’t effectively pump blood out to the body. Blood backs up into the lungs and leads to breathing problems. When wheezing is involved, CHF is called cardiac asthma. CHF generally affects the elderly; one third of these older CHF patients have cardiac asthma.

RELATED: Causes of chest pain

Gastrointestinal Issues

11. Gastroesophageal reflux disease (GERD)

GERD, also called acid reflux, is when acid from the stomach contents comes up into the esophagus. This happens because the sphincter between the esophagus and stomach does not close tightly after food passes. “[The acidic contents] can irritate the throat and sometimes even be inhaled into the lungs,” says Dr. Hui. “This can cause respiratory symptoms like airway tightening, which can lead to wheezing.”

Lifestyle causes

12. Smoking

The chemicals in tobacco products are lung irritants. They inflame the airways and cause a buildup of mucus, both can cause wheezing. Young children who live with smokers and breathe in secondhand smoke are particularly susceptible to breathing problems. The Asthma and Allergy Foundation of America notes that 40% of children who go to the emergency room because of asthma live with smokers.

RELATED: What happens when you quit smoking?

13. Stress

Stress and asthma can go hand in hand. One study of children who were exposed to high levels of stress had a three-fold increase in asthma symptoms in the weeks following the stress. Researchers suspect that stress may change the body’s inflammatory response to the irritants and allergens that often trigger asthma.

14. Foreign body

Wheezing can occur when a foreign body—such as a piece of food or an object like a small toy—gets inadvertently inhaled and lodged in the lungs.

Is wheezing serious?

Wheezing is an indication that you’re having problems breathing that can lead to a medical emergency. Seek immediate medical help if you or someone you’re caring for has:

A severe problem breathing
Passed out
A bluish tint to skin (which indicates the body isn’t getting enough oxygen)
Wheezing that occurs suddenly, say after eating a particular food or taking a particular drug (this could signal a life-threatening anaphylaxis allergic reaction)
Wheezing that occurs after ingesting a small object

When is a call to the doctor warranted? If you hear or feel a wheeze, but breathing isn’t labored and you don’t experience any of the above symptoms, then make an appointment to see your physician. “My advice to patients is if you’re super worried, go to the ER,” Dr. Neal says. “But if you’re not super worried and it doesn’t seem like an emergency, it’s still a good idea to reach out to your healthcare provider. Doctors know their patients best, and they can best tell you whether you need to come in and get seen or if you should head to the ER.”

It’s also important to make an appointment with your provider if your wheezing never really improves or keeps coming back.

How to stop wheezing

Healthcare providers will ask about your symptoms and diagnose wheezing by listening to your chest with a stethoscope. Other office tests, such as a spirometry reading in which you forcefully breathe out into a tube called a spirometer, can tell a physician how well your lungs are working. Depending on what your doctor may suspect is causing your wheezing, other tests, such as a pulmonary function test or a chest X-ray may be ordered.

Medications

What medications treat wheezing? Bronchodilators relax the airway muscles and are first-line treatment for wheezing. “Albuterol is the classic rescue medication,” notes Dr. Neal. It’s a short-acting bronchodilator typically delivered via an inhaler or nebulizer (a machine that turns liquid medicine into a mist to be inhaled). It’s considered a “rescue medication” because it works quickly but doesn’t give long-lasting results. Your provider may prescribe other bronchodilators or steroids to ease inflammation.

Of course, treating the underlying cause of wheezing is an important component to controlling the symptoms. “If GERD is causing respiratory concerns, for example, then treatment of the GERD is optimal,” explains Dr. Hui. “Sometimes we find that the cause is multifactorial. The patient may have asthma, GERD, and stress—in which case, it’s important to address all contributing factors.”

At-home remedies for wheezing

There are no at-home remedies for wheezing, but you can avoid what triggers your asthma. Get vaccines to protect yourself against the flu and COVID-19. If GERD is an issue, avoid foods that can lead to acid reflux, such as alcohol, chocolate, and tomato products, don’t eat within three hours of bedtime, and sleep with your head propped up. When you have a cold or your child has the croup, increase fluid intake and use a humidifier to help thin mucus secretions. While these measures won’t decrease inflammation in the lungs, they can ease congestion so you can move air in and out of your upper airway more easily. For persistent wheezing, it’s best to get professional medical advice from a physician. If you have shortness of breath, visit an emergency department or call 911.

Asthma Heart health