Plan for treating my wheeze

What is wheeze?

Wheeze is a whistling noise made in the chest, usually when breathing out. It happens when the airways (tubes carrying air to the lungs) become inflamed and narrowed, this is often due to a viral infection (cough or cold).

Wheeze is extremely common in young children. One in three children has at least one episode of wheeze before their third birthday.

Is this asthma?

Most pre-school children with wheeze do not have asthma.

Young children can wheeze with colds, but they usually grow out of it by the time they start school.

However, some will continue to have wheezy episodes which are triggered by things other than just a cold, for example exercise, pollens, animal fur and so on. Your doctor may then give you the diagnosis of ‘asthma’. Children with asthma often have a family history of asthma, eczema, or allergy.

What treatment is needed?

A ‘reliever’ inhaler such as Salbutamol (blue inhaler) may be prescribed to be given using a spacer device.

Occasionally a ‘preventer’ (steroid) inhaler is needed as well.

Antibiotics are not useful against viruses, so are of no use in viral induced wheeze. Similarly, oral steroids are rarely needed in viral induced wheeze in pre-school children.

What are relievers?

These are inhalers which, when breathed in, work directly on the airways bringing almost instant relief from symptoms of cough, wheeze, and breathlessness.

What are preventers?

Preventers help to stop the airways becoming narrowed and inflamed. A preventer is an inhaled steroid which will reduce the number of times the wheeze gets worse and the chance of having to go to hospital with bad wheeze.

If a child is needing their reliever every day, and not just with colds, then their wheeze is not well controlled, and you will need to speak to their doctor or nurse as they may need a preventer.

How should inhalers be given?

Inhalers should always be given through an appropriately sized spacer device. This makes it work much better as it gets the medicine into the lungs where it is needed. It’s better if the child is sitting up when using their inhaler and spacer.

How to use:

1. Shake the inhaler before use and after every puff
2. Remove the cap from the inhaler and fit it to the opening of the spacer
3. Place the mask over your child’s mouth and nose, or if using a mouthpiece, place it in their mouth (ensuring a good seal)
4. Press the inhaler once (puff) into the spacer and then take 5 slow breaths or leave it on for 10-15 seconds if the child is breathing very fast
5. Remove the spacer and shake the inhaler between each puff
6. Repeat the process until the prescribed number of puffs have been given
7. Plastic spacers should be washed every month as per manufacturer’s guidelines

Follow this action plan when deciding how often to use inhalers

If I am generally well but having an occasional cough, wheeze or breathlessness episode I take my reliever, usually salbutamol (blue inhaler)

My inhaler should be taken before exercise if exercise normally makes me wheezy

What should I do if my wheeze symptoms are suddenly worse?

If I’m unwell and have a cold with wheeze, cough or shortness of breath:

• I take 4 puffs of my reliever every 3 to 4 hours
• If I am needing this for more than 1 to 2 days I need to see my GP

What if my wheeze is severe?

Whilst I wait for an ambulance or emergency department review, I can use my reliever again, every 30 to 60 seconds (up to 10 puffs in total). Stay sat up and try to be calm

Even if I feel better, I still need to see my doctor today

What other medications do I take to prevent symptoms?

Sometimes your doctor may prescribe other medicines to help with your wheeze, these may include preventers, or oral steroids.

Follow this discharge plan after being sent home from hospital

Do I need to be seen again?

If your symptoms are no better over the next few days, you should get checked by your GP. If your doctor has said you have asthma you should arrange to see your GP or asthma nurse within the next 48 hours even if you are feeling better.

Where can I seek help?

• If it is non-urgent, you can speak to your local pharmacist
• If the child has any of the features of their wheeze getting worse urgently see your GP. For an urgent out-of-hours GP appointment, call NHS 111- call 111
• You should call 999 or go your nearest A&E department in critical or life-threatening situations