What should you know about a COPD wheezing sound?

Wheezing often becomes clearer when breathing out, although narrowed airways can produce noisy breathing in other phases too. In COPD, airflow limitation can make this sound more noticeable during a flare-up, with cough, mucus or breathlessness. A wheeze alone cannot identify its cause. Asthma, acute bronchitis, allergic rhinitis, bronchiolitis and a severe allergic reaction can also affect airflow. The timing, triggers, age, associated symptoms and examination findings guide assessment.

If wheezing is new, recurrent or interfering with activity, arrange a clinical assessment. Note when it starts, whether it follows exercise, smoke, dust, a cold or an allergen, and whether cough or chest tightness occurs. Use prescribed reliever medicine only as directed. A nebuliser treatment may be considered by clinicians when inhaled medicine needs to be delivered during acute breathing difficulty; it is not a substitute for emergency care.

Seek emergency help for wheezing with swelling of the lips, tongue or throat, sudden widespread hives, faintness, severe breathlessness, blue or grey lips, confusion, or difficulty speaking. Sudden symptoms after food, medicine or an insect sting may indicate anaphylaxis. Rapid deterioration, severe chest pain or a silent chest also needs immediate care. Do not drive yourself if breathing is severely impaired.

What is most likely causing my wheeze? Do I need testing for asthma or COPD? Which inhaler should I use, and what warning signs mean I need urgent help?