Wheeze: the lower-airway whistle
A wheeze is a high-pitched, musical whistle produced when air squeezes through narrowed lower airways. It is usually loudest on breathing out, because airways naturally narrow during expiration. Wheeze is the signature sound of asthma and other causes of bronchospasm, where the muscle around the airway tightens. When many airways narrow unevenly, you hear a chorus of whistles at different pitches.
A close relative is rhonchi — lower-pitched, snoring or rattling sounds caused by thick secretions or mucus moving in the larger airways. Rhonchi often clear or shift after a cough, whereas a true wheeze persists. Distinguishing the two helps separate a mucus problem from a muscle-tightening problem.
Stridor: the upper-airway warning
Stridor sounds superficially like wheeze but means something different and often more urgent. It is a harsh, single-note sound from narrowing of the upper airway — around the larynx or windpipe — and it is usually loudest on breathing in. Whereas wheeze comes from many small lower airways, stridor comes from one big obstruction high up: a swollen voice box, an inhaled object, a tumor, or croup in a child.
Chest pain that moves with the breath
Not all chest pain is the heart. Pleuritic chest pain is a sharp, stabbing pain that gets worse with a deep breath, cough, or movement, and eases when you hold still. It comes from the pleura, the two thin membranes lining the lung and chest wall: normally they glide silently, but when inflamed they rub and catch with each breath. The pain is often well-localized — patients can point to it with one finger.
- Ask whether a deep breath makes it worse — the hallmark of pleuritic pain.
- Pin down the location: sharp and pointable favors the pleura; central and crushing favors the heart.
- Look for company — fever (infection), sudden breathlessness (clot or collapse), or recent injury.