Little Lungs, Big Care! Tips to manage wheezing/asthma

What is Wheeze?

Wheezing is a high-pitched sound caused by narrowing of the small airways in the lungs. It often accompanies breathing difficulties and occurs in both viral-induced wheeze and asthma attacks. Not all children with viral-induced wheeze will develop asthma.

Childhood Wheeze vs. Asthma

• Wheeze: Often triggered by viral infections; many children outgrow it by school age.
• Asthma: A long standing condition where symptoms like wheeze, tightness in the chest, and night-time coughing occur more frequently. 

Common Triggers

• Viral infections, pollen, dust mites, smoke, cold weather, stress, and exercise.
• One common trigger is cigarette smoke. Research shows that even smoke residue on clothing can increase a child's risk of recurrent wheeze.

Asthma Diagnosis

• Based on symptoms and, in older children, tests like spirometry or peak flow. Allergy tests may also be helpful.

Controlling Asthma

• Use a Personalised Asthma Action Plan (PAAP) to monitor symptoms and manage treatment. This is usually provided to patients diagnosed with Asthma.
• Ensure reliever inhalers are always accessible.
• Encourage exercise, while monitoring asthma triggers.

Signs of Breathing Problems

Look out for the following:

• Rapid breathing.
• Tummy or throat "sucking in" with each breath.
• Wheezing or grunting noises.
• Difficulty speaking in full sentences or engaging in usual activities.
• Complaints of chest tightness.
• Extreme tiredness or difficulty waking up.

Emergency Treatment

• If your child experiences worsening symptoms, follow your PAAP instructions and administer Salbutamol as directed.
• Seek urgent medical help if symptoms do not improve after 10 puffs or if your child has severe symptoms (e.g., blue lips, exhaustion).

Treatment for Wheeze

Treatment may vary depending on whether your child has asthma or a viral infection.

Medications

1. Salbutamol (Blue Inhaler)

• A medication that relaxes and opens the small airways
• Helps improve airflow to and from the lungs.
• Use with a spacer device for effective delivery.

2. Pain Relief (Paracetamol/Ibuprofen)

• Reduces fever or discomfort caused by a viral infection.

3. Antibiotics

• Not prescribed for viral infections as they do not work against viruses.

4. Steroids (Prednisolone/Dexamethasone)

• May be prescribed for a few days for children with asthma.

5. Blood investigations and x-rays are usually NOT needed in most cases.

General Care

• Encourage your child to eat and drink small amounts regularly during their illness.

Asthma Treatments

Inhalers

1. Reliever Inhalers 

• Provide immediate symptom relief by opening airways.
• Usually contain a medicine called Salbutamol

2. Preventer Inhalers

• May contain steroids to reduce airway inflammation.
• Must be used daily, even when symptoms are absent.

Spacers

• Help ensure medication is delivered to the lungs effectively.
• Recommended for all ages, with masks provided for younger children.

If you have been to the emergency department for wheeze, ensure the following steps are completed before discharge:

• Inhaler technique reviewed and confirmed.
• Explanation of medicines and at-home treatments.
• Some hospitals may provide a Count It Out chart to keep a track of when your inhaler will run out.
• For asthma diagnoses, a Personalised Asthma Action Plan is supplied.
• Advised to arrange a GP follow-up within two working days.

At Home

After discharge, your child may need additional doses of their blue inhaler. Over the next few days:

• Observe your child at least every 4 hours, including overnight.

If Breathing Problems Occur

Mild Symptoms

• Give 2 puffs of Salbutamol using the spacer device.
• Reassess in 5–10 minutes. If no improvement, give another 2 puffs (up to a total of 6 puffs).
• Repeat every 4 hours as needed.
• If still requiring 6 puffs every 4 hours after 24 hours, arrange an urgent GP review.

Severe Symptoms or No Improvement After 10 Puffs

• Call 999 immediately if:
  • Symptoms worsen.
  • Your child has blue lips or is too breathless to speak.
• While waiting for an ambulance, administer another 10 puffs of Salbutamol.

Additional Notes for Parents

• Ensure everyone caring for your child understands how to use inhalers and spacers.
• Keep a spare inhaler and a peak flow meter (if applicable) handy.
• Discuss with your GP whether your child should have the nasal flu vaccine annually.
• Avoid exposure to smoke and other triggers.

If in Doubt

Always contact your GP, call 111, or, in an emergency, dial 999 if you are concerned about your child's breathing or asthma symptoms.