Simple Ways to Stop Wheezing with Neha Solanki, MD

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials podcast. I'm John Horton, your host. Breathing should be a relatively quiet experience with just the soft sound of air going in and air going out. But at times, there may be a little something extra that comes with each breath, like a high-pitched whistle or a rattling noise. This wheezing is caused by an unwelcome tightening of the airways that can be caused by any number of factors. When it happens, though, there are things you can do to open your airways up and keep the air flowing.

We're going to put a wheezing action plan together today with the help of pulmonologist, Neha Solanki. Dr. Solanki is one of the many experts at Cleveland Clinic who pop into our weekly podcast to chat about our health. So with that, let's focus on our breathing and how we can silence any wheezing.

Welcome back to the podcast. It has been far too long since you joined us.

Dr. Neha Solanki:

I am so happy to be here. Thank you for having me.

John Horton:

So you're here to talk about wheezing, and that's one of those things that really can get you worried when it hits.

Dr. Neha Solanki:

Yes.

John Horton:

As a parent, I remember putting an ear to my kid's chest more than a few times. You're listening for that rattling and whistling sound. And I know I've heard it in my own breathing over the years from time to time, too. So it's a little unsettling, to say the least.

Dr. Neha Solanki:

Yeah. So wheezing can be caused by a lot of different things. It can be unsettling because why are your lungs making a noise?

John Horton:

Right. There's nothing worse. They don't make any noise.

Dr. Neha Solanki:

Why am I doing this? This shouldn't happen. No, but generally speaking, it's very common in asthma. It is basically caused by narrowing of the airways, inflammation of the airways, and you'll hear this high-pitched whistle if it's caused by asthma.

John Horton:

Is there something that... What triggers it? It sounds like a bunch of different stuff can trigger it, right?

Dr. Neha Solanki:

Oh, definitely. So we tend to, when we hear wheezing, we tend to think, "Oh, this is asthma." However, a lot of different things can cause it. So allergies can cause it. Respiratory infections, meaning if you have a cold, that can cause it. Anytime you have any mucus in your lungs, right? So if you get a cold, it can develop mucus. Congestion, that can cause it. People who have COPD, heart failure could also develop or have wheezing. So there are many different causes. You could also wheeze if you aspirate. So say you're eating peas for dinner and then a pea goes into your lungs, that can also cause wheezing.

John Horton:

The old wrong pipe thing.

Dr. Neha Solanki:

Yes. And then there can also be wheezing if you have some kind of issue above the lungs. So there's many, many different causes to wheezing, but the most common is asthma.

John Horton:

Okay. I saw where sleep, it can show up, GERD, air contamination. I mean, all of these factors can come into play too.

Dr. Neha Solanki:

Yes. So what we like to say is all that wheezes is not asthma, but absolutely, there are things like reflux. Anything that can cause mucus such as air contamination, which causes inflammation, can cause wheezing.

John Horton:

So when you put your ear to somebody's chest and you're listening for this, and parents, you do this all the time, what are you hearing? Because it is such a weird noise. It's almost like when you have a balloon stretched out and you're slowly letting the air out. You feel like that's kind of like what it is. But is that just you're hearing the lungs trying to force air to move around?

Dr. Neha Solanki:

Yes. So it depends on what is causing the wheeze, what is driving the wheeze. So if you listen to someone's lungs and you hear this high-pitched whistle whenever they blow out, that's coming from very deep in their airways, from inflammation very deep in their airways, which is often associated with asthma. If you listen and you hear this low-pitched wheeze that sounds a little bit like a snore, and it is when you breathe in or out, that's usually mucus, and that is associated with COPD or bronchitis if someone is a smoker.

And then if you hear a wheeze above your lungs when you breathe in, that could be coming from the vocal cord area, and that's usually pretty serious and you need to go see an ER, go to an ER or go to an urgent care because you could have some kind of swelling or infection up there. So there's lots of different kinds. In asthma, the most common kind is when somebody breathes out, they make this whistling sound, high-pitched musical whistling sound.

John Horton:

Yeah, that's so wild, just fascinating that kind of the sound, the pitch of what you're hearing kind of gives you a clue as to what the issue might be.

Dr. Neha Solanki:

Exactly. Yes, yes.

John Horton:

And I'm guessing, you had mentioned the sound, where it's coming from, all that. Is that something that we can hear with our ears, or I'm guessing that might be why you need those fancy stethoscopes that all you doctors so stylishly wear?

Dr. Neha Solanki:

Yes. So sometimes I can hear just by walking into the room depending on how loud-

John Horton:

You have a good ear.

Dr. Neha Solanki:

Yes. Well, sometimes the wheezing is just so loud. It's not even that I have great hearing, which my hearing is pretty average, to be honest. But I'll walk into a room and I hear the wheeze. So you don't always need a stethoscope. However, most of the time you do, and the stethoscope basically magnifies or makes that sound louder.

John Horton:

And it sounds like that sound really is a big clue as to what the underlying issue might be.

Dr. Neha Solanki:

Absolutely. So if I listen to someone's lungs and I am hearing that they have this low-pitched wheeze when they breathe in and out, I know that it's more than their asthma. It's probably some kind of, there's mucus that needs to be thinned out. If I hear something higher pitched, then I know that this is an airway issue and it needs to be treated in a different way. So the lung exam is very important. And that's why sometimes we have a lot of people doing virtual visits for asthma or just generally people doing virtual visits, but it's harder to get a sense of what your lungs sound like if we can't hear them. So I always like when people come in the office for these visits so we can actually listen to your lungs.

John Horton:

So once we have this wheezing and it sets in and we've listened to see what notes we're hitting and all that stuff, I think what everyone wants to know is how do we stop wheezing and get our breathing back to normal? Are there some handy things we can do at home to get things open and that air flowing?

Dr. Neha Solanki:

Yes. So if it's very mild wheezing, you have a very, very mild, it kind of comes and goes. Say you have a cold and you are trying to get over this cold and you're making mucus production and this mucus production is causing you to have noises in your lungs and you kind of just want to get rid of those noises, at that point, you can drink warm liquids, warm tea, and what that's going to do is it's going to help thin the mucus out so you can loosen it up and you can get it up a little bit easier. Then you have some people, if you've noticed, taking a hot bath or taking a hot shower can have the same effect on the mucus. And again, we're talking about noises coming from the lungs in the setting of something like an infection or allergies or relatively mild causes of mucus. If it's more than that, you need your inhaler.

John Horton:

And that would be more of, like you said, that rattle, that deeper rumble when you're hearing that, when you might want the liquid.

Dr. Neha Solanki:

The deeper rumble. Yes.

John Horton:

I think humidifiers are good for that too. I know my wife was always, when the kids were sick, man, that humidifier was just running in their bedrooms overnight.

Dr. Neha Solanki:

Yes. And what I would actually recommend, and I have this myself, you can get a small device that will measure the humidity in your bedroom so you know whether it's too humid or not humid enough. So sometimes in the winter, especially where we live, it gets very cold and very dry, and that can also cause your airways to start constricting and for you to start wheezing. And in that case, you know, oh, the humidity is very low. It's like 17% or 15%. You need a humidifier.

John Horton:

What should your target humidity be?

Dr. Neha Solanki:

I like to keep it around 40 to 50%.

John Horton:

Makes sense, right in the middle.

Dr. Neha Solanki:

Right in the middle, yeah.

John Horton:

Anything more than that, I guess you're going to get more tropical rainforest, which is probably more than what you're looking for.

Dr. Neha Solanki:

Then you have a tropical rainforest and then it becomes very heavy. The air becomes very heavy, and that can also make it difficult for you to breathe. So you want a nicely humidified environment, but not too humidified.

John Horton:

And you said all this moisture just keeps that mucus from gumming up, right? It lets it just, I guess, ick around a little bit easier and not get stuck in there?

Dr. Neha Solanki:

That's right. So what happens to mucus is it can thicken and harden, and then when it hardens like that in your airways, the air has a hard time getting out and then it'll make noises. Your lungs will make noises because the air is struggling to get out. So if you are able to thin it out, you can breathe easier, essentially. So the steam from a bath or a shower or tea or hot water generally can help loosen you up a little bit.

John Horton:

Okay. I got to tell you right now the highlight of the podcast for me is going to be the fact that I used the term ick around and you said that's right. I did not know if that would be a medically appropriate term, but-

Dr. Neha Solanki:

But I understood. Language is just so we understand each other. As long as I understand you, it works.

John Horton:

I have three kids, two grandkids. I've dealt with a lot of icky stuff, so it did seem to be the thing that fit best. And then you had mentioned other triggers that could set it off. And we've kind been talking about the illness or mucusy stuff, but then talk about then maybe the things that can cause that high-pitched sound and what we can do about it.

Dr. Neha Solanki:

So when you have that high-pitched sound, that is wheezing from your asthma and your airways are getting smaller and they're inflamed, and in that case, I would recommend using your inhaler because you don't want it to get to a point where it just closes. You want your airways to remain open. So in that case, I would go straight to an inhaler.

John Horton:

Can people get that even if they don't have asthma? Can you get kind of asthma-like symptoms just as like a one-off if you're in a really a bad situation, like around a lot of smoke or something like that?

Dr. Neha Solanki:

Yes, it's situational reactive airways. You're somewhere where there's air contamination or some other trigger and your airways become very hyper reactive and it can become an asthma-like situation, but it hasn't progressed into full-blown asthma. But it might mean that you're somebody who... Asthma's a spectrum, so you might be somebody who's more prone to getting asthma in the future under the right circumstances. So it's something to keep an eye on.

John Horton:

If you're somebody who hasn't been diagnosed, you don't have that inhaler, can you just try those things you mentioned previously to maybe help loosen it up or are there other things you might be able to do to get the breathing going?

Dr. Neha Solanki:

Sure. So the things we discussed, and there's ways you can breathe that can also help breathing. But what you're doing with that, I like to explain the lungs as made up of many, many tiny balloons. So your right and your left lung, they look like they have lot of tiny balloons filled with air, essentially. And what's happening is you want to make it so that the air will come out of the balloons easily so they have time to get out of those balloons. So what you do is you can take a breath in and then exhale very, very... You exhale fully. And so what happens is then the air has time to slowly come out. So you could try to control your breathing through pursed-lipped breathing or control that sensation through pursed-lipped breathing, but if it continues, you probably should see a doctor.

John Horton:

So when you do that pursed-lipped breathing, it sounds like it's slowing your breathing down. So you take that breath in and you blow those little balloons up, and then you take a long, deep exhale and make sure that you shrink that balloon all the way down so that there's no air left over.

Dr. Neha Solanki:

That's right.

John Horton:

What does that do? Is that just a matter of when you're clearing everything out, all that air out, are you forcing those airways open a little bit more just from pushing that air through or is it just a matter of making those balloons work for you?

Dr. Neha Solanki:

So what you're doing is you're increasing the amount of time the air in your lungs have to exit because when you wheeze, your airways are getting very small and so the air is getting stuck and you're breathing too quickly, so the air is just not having enough time to escape your lungs and get out. And that can cause chest tightness, chest pressure. So what you want to do is you want to give your lungs time to really let all of that air out. And the way to do that is to make your exhalation long so you can help your lungs by slowing down your breathing.

John Horton:

How long does that kind pursed-lipped breathing technique take to maybe address wheezing or minimize those symptoms?

Dr. Neha Solanki:

I would say 10 to 15 minutes if it's going to work. But if it doesn't work, again, you should see a doctor.

John Horton:

See somebody. Yeah.

Dr. Neha Solanki:

You need an inhaler probably.

John Horton:

Now, we've been talking about those kind of immediate solutions, the humidity, the pursed-lipped breathing, things like that. I also read where there's long-term things you can do, and one of them was diet, which I just found really fascinating that that be something that might be able to help with wheezing symptoms. Is there any truth to that?

Dr. Neha Solanki:

There's so much we don't know for sure. I will say that there is research being done right now at Cleveland Clinic about diet and asthma. And I think that what we're finding is that if you eat a diet high in omega-three fatty acids, it actually may help your asthma.

John Horton:

Wow.

Dr. Neha Solanki:

And also, anti-inflammatory foods probably do make a difference. The evidence isn't conclusive. But I think that there are lots of reasons to believe that eating a healthy diet will decrease overall inflammation, and that inflammation is also in the lungs and in the airways. So I think the healthier you can eat, the more omega-three fatty acids, I think, can also help improve your health long-term.

John Horton:

Yeah, that makes a lot of sense. And I know we talk a lot on this podcast about just inflammation's everywhere, and if you do kind of limit the foods that cause it, it makes everything work better. It makes sense that the lungs would be tied into that, too. When should folks look at wheezing as an issue that needs medical attention, that you got to get in there and you need to see somebody right now?

Dr. Neha Solanki:

So whenever wheezing is associated with chest pain or chest pressure or if somebody is having a hard time breathing or even talking, so you're having a hard time stringing words together, you're having a hard time with activities, you should see someone right away.

John Horton:

What about if this comes up routinely? We mentioned that there could be a one-off. You're out somewhere and just something in the air bugs you and you kind of get that, and then it goes away and you never have it again. If you're somebody who just you notice every year during a certain time when the magnolia tree blooms and you have these issues, is that where you should go and talk to your healthcare provider and be like, "Hey, listen, I'm noticing this trend"? Maybe there's something that you can do to stop it from happening and get ahead of it.

Dr. Neha Solanki:

So some people do have this... It's a very seasonal, very specific trigger to this wheezing. And sometimes it's as easy as taking an allergy medication or there are other oral medications that can help. And some people, what we do is they are on an inhaler just for six weeks that they're affected by the pollen or whatever tree is blooming and then they go off of it. So the thing with asthma is that it is something that comes and goes. So once we identify what that trigger is, you can then create a plan around that trigger. It doesn't mean that you're always on an inhaler, you're always on medications, but just during that time, you want to make sure your lungs don't suffer any damage from the inflammation. So if you leave inflammation uncontrolled, you can end up scarring your lungs, just like you can scar any part of your body. So it is important to follow up and just be treated for that brief amount of time, and then you can then go off the medications if they're not needed.

John Horton:

Yeah. If you're one of those stubborn people, not naming names, but just say, I know I have a friend.

Dr. Neha Solanki:

You have a friend? We all have friend.

John Horton:

We all have a friend.

Dr. Neha Solanki:

We all have a friend.

John Horton:

But who kind of fights that and you have that time of year where you know it's bad, but you don't take your allergy med or whatever, pop that little pill once a day. If you let it go, will it possibly develop it into more and become a little bit more of a chronic issue and become more trouble down the line?

Dr. Neha Solanki:

So people are different. Certainly there are people who can get through it. However, what I would worry about is that if inflammation is left untreated, it can become persistent inflammation. And once it becomes persistent and you're not treating it, then it can scar. So if you ignore it and you are ignoring it often, then it can become a chronic condition and that's what you want to avoid. You don't want a chronic condition. You want to just, there's inflammation, take care of the inflammation, move on. But obviously people are different and if somebody wants to, all we can do is make a recommendation and then it's really up to the person to decide what is right for them. So I would recommend that if you are having these symptoms, then you do get treated, you do decrease the inflammation and then you can go off the medication.

John Horton:

Breathing, it's an issue. And when you start having trouble, like I said, it's a little shocking and you don't quite know what to do. You get a little panicky. I mean, you need that air to go in and out and when it doesn't work right, you're kind of like, "What do I do?"

Dr. Neha Solanki:

Right, right. Breathing is, you don't realize how important it is until you can't breathe the way that you should or that you've grown accustomed to. It's very important. So it's very important to take care of lung health for that reason so it doesn't become a chronic condition down the road.

John Horton:

So don't ignore that wheezing if you're noticing it frequently popping up or certain times.

Dr. Neha Solanki:

Right. I mean, if it happens once in a while, that's fine, but if it's something that's persistent, it's definitely something that you should see somebody about because you don't even know that it's asthma. It could be something else entirely. And so there are lots of different airway issues that can cause wheezing and you should be checked out before you ignore it.

John Horton:

And I know we've talked about a lot of the different factors that can go into it. And one we didn't mention, which I feel like we just have to, is smoking. And I know that it is just not good for the lungs and there's so many ways to cover that, but it sounds like don't do it, get away from it if you can. It's just, it's not going to make things better.

Dr. Neha Solanki:

Smoking is really bad for the lungs. Secondhand smoke is also bad for the lungs. And now of course we're seeing a lot more vaping. Vaping is bad for the lungs and smoking marijuana, we're now learning has very similar effects on the lungs compared to smoking cigarettes. So people who are chronic marijuana smokers can develop emphysema, which is chronic destruction, irreversible destruction of the lungs. So anything you inhale is potentially damaging to the lungs, and I would really urge people to think twice because it's very hard to get a new set of lungs. It's not impossible, but it's very, very hard and you don't want to put yourself in a position where that's what you need.

John Horton:

Yeah, it does seem like something that would be a little more complicated, not an outpatient sort of procedure.

Dr. Neha Solanki:

Not an outpatient. You have your set of lungs. Take care of them.

John Horton:

Great advice. We can all work on it a little bit.

Dr. Neha Solanki:

Let's take care of them. Yes, yes.

John Horton:

So with everything that we've talked about, and I think you've kind of really laid out a plan with people, if you have wheezing to know how serious it is, kind of find that cause, take some steps to address it. What's the one thing you want people to take away from this discussion when they're thinking about their breathing and if they are experiencing that high-pitched sound or those rattles pretty routinely?

Dr. Neha Solanki:

You should see your doctor and you should get that worked out because it can be many things and it's hard to know without some appropriate testing what exactly is going on. So I worry about self-treating at home because you could be letting another condition get worse. So it's important that you see your doctor try to get a diagnosis for the wheezing and then you can decide what is the best way to manage it.

John Horton:

All right. Well, that's great advice as always, Dr. Solanki, and I appreciate you coming in and getting us going in the right direction so that we can keep our lungs working. It does sound like they're very hard to find replacement parts.

Dr. Neha Solanki:

Very hard to find replacement parts. I do not recommend.

John Horton:

Well, thank you again for coming in on that note, and looking forward to talking with you sometime in the near future.

Dr. Neha Solanki:

Okay, thank you for having me.

John Horton:

The whistling and rattling sounds that come with wheezing can be pretty alarming. Oftentimes, though, you can take care of the issue with some simple at-home treatments or just by avoiding potential triggers in the first place. If that doesn't help, find some time to chat with your healthcare provider, get your breathing under control. If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

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