RESP - Viral Wheeze

Question 1

Definition of Viral Induced Wheeze.

Answer 1

Acute wheezy illness caused by a viral infection. Between colds, children are usually free of the wheeze (unlike in Asthma).

Question 2

Classification of Pre-School Wheeze (2).

Answer 2

1. Episodic Viral Wheeze (only when there is an URTI and symptom-free in between episodes).
2. Multiple Trigger Wheeze (caused by viral URTIs, exercise, allergens and cigarette smoke).

Question 3

VIRAL-INDUCED WHEEZE vs. Asthma (3).

Answer 3

1. A presentation before the age of 3.
2. No Atopic History.
3. Presentation only occurs during Viral Infections.

Question 4

Epidemiology of Wheeze (2).

Answer 4

1. 25% of children have an episode of wheeze before 18 months.
2. One of the commonest diagnoses on wards.

Question 5

Pathophysiology of Viral Induced Wheeze/Bronchiolitis (3).

Answer 5

1. Small airways encounter a virus.
2. Inflammation and oedema (bronchoconstriction + swelling causes restricted airflow).
3. Poiseuille’s Law (huge difference).

Question 6

Clinical Features of Viral-Induced Wheeze (3).

Answer 6

1. Shortness of Breath.
2. Signs of Respiratory Distress (restricted ventilation).
3. Expiratory Wheeze Throughout Chest (airflow through narrow airways).

Question 7

Definition of Wheeze.

Answer 7

High-pitched whistling sound, associated with increasing difficulty in breathing, caused by air flowing through narrow airways.

Question 8

Management of Viral-Induced Wheeze.

Answer 8

1. Episodic Viral Wheeze - symptomatic treatment (1st line SABA or Anti-Cholinergic; 2nd line - LRA or Intermittent ICS).
2. Multiple Trigger Wheeze - Trial of either ICS or LRA for 4-8 weeks.
3. Admission to ITU and 2mg/kg/day of Prednisolone for 3 days (if severe).

Question 9

Investigation and Management of Focal Wheeze.

Answer 9

Prompt further investigations check for focal airway obstruction (urgent senior review).