Following Your Child's Wheezy Episode

Viral-induced wheeze is when the tubes carrying air to the lungs (airways) become irritated and inflamed by a cold virus.

This causes the tubes to swell and narrow, making it more difficult for your child to breathe.

Viral-induced wheeze is common, affecting nearly a third of all children, but your child is more likely to develop it if they were born early, if they have ever had bronchiolitis or if they are exposed to cigarette smoke.

No, although the flare-ups (exacerbations) appear very similar to an asthma attack and the initial treatments are the same. Children with viral-induced wheeze, however, are completely well between episodes, unlike children with asthma. Most children with viral-induced wheeze will slowly improve year on year and often grow out of the condition completely by the time they reach school age.

A small number of children go on to develop asthma.

Asthma is a condition that affects the small airways (small tubes) in the lungs. The airways are sensitive and become inflamed, becoming narrow when they come into contact with a trigger or an allergen.

Sometimes the triggers or allergens cannot be identified:

• common triggers include viral infection/colds, exercise, cold weather or cigarette smoke

• allergens may include pets, pollen, dust mites and foods.

When a child with asthma comes into contact with these triggers or allergens the airways become narrow, inflamed and swollen.

The airways become blocked with mucus, this makes it very difficult for air to get in and out of the lungs.

Please ensure someone has been through each of these with you and you feel happy that you know enough about each of these:

• If needed, how much reliever and preventer inhaler / medicine my child should take, and how often.
• If my child has been prescribed steroids, how many he or she should take and for how long.
• My child and I know how to use his or her inhaler and spacer effectively.
• The importance of my child having his or her reliever (blue) inhaler with them at all times and taking their preventer medicines regularly (if prescribed).
• When my child’s next appointment with a health professional should be.
• How to recognise when my child’s symptoms are getting worse.
• What to do if my child has another episode of wheezing.
• Does my child need a personalised asthma plan?

Please do not hesitate to ask any of our staff if you feel you would like further clarification about any of the above points before you go home, and we will ask one of our specialist children’s asthma team to get back to you about this as soon as feasible.

Day 1: Give 8 puffs of reliever 4-hourly for 24 hours.

Day 2: Give 6 puffs of reliever 4-hourly for 24 hours.

Day 3: Give 4 puffs of reliever 4-hourly for 24 hours.

Day 4: Give 2 puffs of reliever 4-hourly for 24 hours.

From then on give 2 puffs of reliever 4-hourly, as required.

If your child has been given steroids the dose and number of days will be explained to you.

Make your child an appointment with your GP or practice nurse for a review within 48 hours of their wheezy episode or once you are discharged, to make sure their symptoms are back under control or in case you need any additional medication.

• The common cold.
• Allergies.
• Irritants, like tobacco smoke.
• Heightened emotions.
• Air pollution, especially from traffic.
• Physical activity, particularly in cold weather.

Visit the Asthma UK website at asthma.org.uk for further information.

It is important to remember to have your child’s inhaler and spacer with you at all times!

• You feel like the medicines are not working as well as they do normally.
• He or she needs the reliever inhaler more often than every four hours.
• He or she needs the reliever inhaler more than three times a week.
• He or she wakes at night coughing or wheezing and short of breath, or has a tight chest.
• He or she has to take time off from school or pre-school because of breathing problems.
• He or she cannot keep up with the normal level of activity or exercise.

If your child’s condition is getting worse, make sure they are taking their medicines correctly and make an appointment for them to see their doctor or nurse. If they are unable to last four hours between doses of reliever inhaler, repeat the dose but seek urgent medical attention that day.

Keep a diary of symptoms, triggers and the use of inhalers.

Take this, along with your child’s inhalers and spacers, to all our hospital appointments.

• is wheezing 
• is distressed 
• is struggling for breath 
• is unable to talk in full sentences/suck a bottle 
• needs the reliever (blue inhaler) in less than three hours from his or her previous dose 
• changes colour or has blue lips.

Give one puff of the blue inhaler every 30-60 seconds up to 10 puffs, then wait for five minutes.

If there is no sign of improvement, call 999 for an ambulance, stating your child is having a ‘severe asthma attack.

If you are waiting longer than 15 minutes for an ambulance, repeat the 10 puffs.

Even with improvement, make an appointment to see your doctor or nurse today.

Asthma UK Helpline: 0845 701 0203 Website: www.asthma.org.uk

Allergy UK Tel: 01322 619898 Website: www.allergyuk.org

The British Lung Foundation Tel: 0207 8315 831 Website: www.lunguk.org

To find out how to give us feedback on your visit or healthcare experience, please visit www.esneft.nhs.uk and search for ‘PALS’ or ‘Your views matter’, or speak to a member of staff on the ward or department you are in.