Asthma without wheezing: Is this possible?

Q: Is it possible to have asthma without wheezing?

Perry / Utah

Yes, it's possible to have asthma without wheezing.

Although wheezing is the most reliable sign of asthma, it's not the only sign or symptom. Other common signs and symptoms of asthma are coughing and shortness of breath.

It's important to understand what a wheeze is. A wheeze is a whistling sound produced by air flowing through a narrowed bronchial tube. It's not a rattling or gurgling sound. Although a wheeze occurs primarily on exhaling, it can be heard on inhaling as well. But a loud sound heard on inhaling is more likely to be stridor than a wheeze.

Wheezing is more common in infants and younger children because their airways are so small that any obstruction can cause breathing difficulties. But wheezing may also be heard in adolescents with asthma.

However, airflow limitation due to a narrowed airway doesn't always produce an audible wheeze. Instead, airflow obstruction may result only in signs and symptoms of chest tightness, cough, increased effort to breathe or decreased exercise tolerance.

Regardless of symptoms, lung function tests should be done at the time of an asthma diagnosis and at least annually after that as long as symptoms are present. A key diagnostic criterion for asthma is reversible obstruction on lung function tests.

In older children and adults, lung function tests can be used to make an asthma diagnosis. But these tests are less practical in very young children because they require cooperation and understanding to get good results. Children usually don't develop these skills until they're 4 years old. Although newer techniques are being developed to assess lung function in preschoolers, an asthma diagnosis is based largely on history and less often on physical examination of the child.