Wheeze

Question 1

Wheeze is extremely common in pre-school children with 25% of children having a wheeze before 18 months.
=> viral induced wheeze is one of the most common diagnosis in paediatric wards.

What are the 2 groups of pre-school wheeze?

Answer 1

1. Episodic viral wheeze: only wheezes when has viral upper respiratory tract infection (URTI) and is symptoms free in-between episodes
2. Multiple trigger wheeze: factors such as exercise, allergens, cigarette smoke, as well as viral URTI trigger wheeze

Question 2

Episodic viral wheeze not assoc. with increased risk of asthma in later life but a proportion of children with multiple trigger wheeze develop asthma.

Answer 2

INFO CARD

Question 3

What is the management for wheeze?

Answer 3

1. Parents who smoke should be strongly encouraged to stop
2. Episodic viral wheeze:

=> symptomatic treatment only

=> first-line treatment with short acting beta 2 agonists e.g. salbutamol or anticholinergic via a spacer

=> next step: intermittent leukotriene receptor antagonist i.e. montelukast, intermittent inhaled corticosteroids or both

3. Multiple trigger wheeze:

=> trial of inhaled corticosteroids or leukotriene receptor antagonist (montelukast) over 4-8 weeks.