S2D: The Symptom to Diagnosis Podcast Wheezing and Stridor
Oct 21, 2021
They dig into distinguishing wheeze from stridor using acoustic clues and why that changes urgency. A case of progressive dyspnea leads to a surprising diagnosis of tracheal stenosis after prior intubation. Practical checklists cover acute stridor causes, ACE‑inhibitor angioedema timing, and when to escalate care. Common pitfalls and high‑yield signs for asthma, COPD, and refractory symptoms are highlighted.
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Escalate Early For Inspiratory Single Pitch Noises
- When exam suggests inspiratory single-pitch noise, call ENT and anesthesia early and urgently for airway evaluation rather than assuming lower-airway asthma.
- Prioritize imaging and specialist airway assessment for chronic but progressive inspiratory sounds.
Acute Stridor Has A Narrow Dangerous Differential
- Acute stridor has a short differential including foreign body, inhalation injury, infection (epiglottitis, retropharyngeal abscess), and angioedema—think rapidly and escalate care.
- ACE inhibitor angioedema is possible even after years on the drug, so don't dismiss it by timing alone.
Absence Of Wheeze Does Not Exclude Asthma
- Do not equate absence of wheeze with absence of asthma; use history of recurrent episodic symptoms and reversibility as diagnostic clues.
- Ask about nocturnal or early-morning symptoms and trial bronchodilator response to assess reversibility.