Viral Episodic Wheeze/ Viral-Induced Wheeze

Question 1

Definition of viral-induced wheeze

Answer 1

Most wheezy preschool children have viral episodic wheeze , triggered by viral upper respiratory tract infections, with no interval symptoms between episodes.

Question 2

What causes viral-induced wheeze, when does it generally resolve

Answer 2

It is thought to result from an abnormal immune response to viral infection causing inflammation and obstruction of the small airways. This usually resolves by 5 years of age, and presumably results from decreased airway size.

Question 3

Risk factors for viral-induced wheeze

Answer 3

Maternal smoking during and/or after pregnancy, prematurity, and male sex. Fhx of early viral wheezing is common

Question 4

Management of viral induced wheeze

Answer 4

1st line: salbutamol

Burst Therapy is often used for viral-induced wheeze
* The child is given 10 puffs of salbutamol using a high-volume spacer. Give a puff every 30-60s
* They are then assessed for a response to treatment
* Repeat every 10-20 minutes
* If they can last 4 hours without the symptoms reappearing, they can be discharged
* They will be given a salbutamol weaning regime for the salbutamol inhaler with a spacer.
* Use inhaler as required at home in further episodes of VIW

Escalate treatment as per ‘Acute asthma’ section
* If mild intermittent wheeze and respiratory symptoms that only occur with viral URTI, consider not giving maintenance treatment but planning a review in an agreed time interval.
* Encourage parents who are smokers to stop
* Follow-up required within 48h of presentation if not admitted to hospital, or 2 working days of discharge