Viral Wheeze | Keeping your child well this winter
As the weather gets colder and winter viruses start to circulate, doctors see increasing numbers of children struggling with recognised breathing problems associated with viral infections. In this post, Dr Daniel Gordon discusses viral induced wheeze, a common condition which affects up to a third of children before they reach school age.
What is viral induced wheeze (VIW)? All children are prone to coughs and colds from viral infections which commonly circulate in the colder months. Some children however may develop a wheeze and chest tightness which can lead to breathing difficulty if not monitored and treated appropriately.
Wheeze is a high pitched noise coming from the chest. It happens when the tubes carrying air to the lungs (airways) become irritated and inflamed by the virus, causing them to swell and narrow.
What’s the difference between viral wheeze and croup? In viral wheeze, the inflammation occurs in the small tubes (airways) within the lungs. The wheezing noise is high pitched and is usually heard on expiration (breathing out). When the child coughs it is often described as ‘wet’ or ‘rattly’.
In croup the inflammation occurs within the voice box (larynx) which is below the throat. This typically causes a seal-like ‘barking’ cough, and can lead to a whooping noise called stridor when the child breathes in.
Both croup and viral wheeze can cause significant breathing difficulty if not addressed promptly. The treatments are different for each condition, and therefore the diagnosis and treatment plan must be made by an experienced healthcare professional.
My child has viral wheeze - When should I worry? For most children viral wheeze is mild, however in some occasions the swelling within the airways can affect the child’s ability to breathe efficiently and eventually they may struggle to breathe.
Signs of breathing distress in children include;
A noticeably faster breathing rate
Audible wheezing without listening through a stethoscope
In-drawing of the muscles under the rib-cage (subcostal recession)
In-drawing of the muscles in-between each rib (intercostal recession)
A ‘pulling’ at the base of their neck
Flaring of the nostrils
Reduced feeding (because the child is devoting energy to breathing)
Becoming more tired or drowsy
These are all signs of breathing distress in children. If any are present you should seek seek immediate medical assistance via your local services.
How is viral wheeze treated? The mainstay of treatment for viral wheeze involves using a blue inhaler containing a medication called salbutamol. This relaxes the airways in the chest, causing them to widen and thereby relieving the limitation. Salbutamol only lasts for a few hours and so repeated doses are given and gradually reduced over a period of days until the virus has run its course and the child is no longer wheezing.
Young children are unable to effectively use an inhaler, so it is usually given through a ‘spacer’ device - A plastic tube which holds the spray from the inhaler and helps it reach the little airways deep in the child’s lungs where it is needed most.
Rarely additional oral medications are needed to help reduce the lung inflammation. These include oral steroids (prednisolone) or a medication called montelukast. Antibiotics are very rarely used as they do not work against viruses.
How can I care for my child at home? If your child has previously been diagnosed with viral wheeze they may have been given a ‘wheeze plan’ by their doctor. This is a document which clearly sets out how to titrate the dose of salbutamol inhaler to the child’s symptoms. It also contains guidance on when further assessment is needed in a hospital setting. Parents who already have a wheeze plan for their child can usually manage them at home according to the plan as long as they feel safe and confident to do so.
Many children with viral wheeze can be managed at home however admission to hospital may be required if the child has significant breathing distress.
What if my child is admitted to hospital? Sometimes children need a period of observation in hospital to ensure that their wheeze is improving. The vast majority of children who are seen in hospital are able to leave within a few hours. Children are kept in for longer periods if their wheeze is slow to respond to treatment, or if they require a period of supplemental oxygen.
If they are kept in hospital they may receive their salbutamol via. Nebuliser rather than an inhaler. A nebuliser delivers a misted form of the medication via an oxygen mask. They will have regular observations taken such as temperature, pulse, breathing and oxygen saturation levels. They may receive a few days of oxygen to support their breathing and/or oral medications.
It is extremely rare for a child with viral induced wheeze to require the support of an intensive care unit.
My child has viral induced wheeze. Will they go on to develop asthma? The majority of children who suffer with viral wheeze will grow out of it by the age of 5. This is why it is often called ‘pre-school wheeze’. If however they continue to have wheezy episodes after the age of 5 they may need further assessment for asthma. The other clue apart from age is what triggers the wheeze - If there are other triggers to the child’s wheezing episodes - Such as exercise or pollen - Then it is more likely they could receive a diagnosis of asthma.
A family history of asthma and other allergies such as hay-fever are important indicators that a child may be more likely to have asthma than a simple viral wheeze.
Disclaimer: This blog post provides general information only. It is not intended to provide instruction and you should not rely on this information to determine diagnosis, prognosis or a course of treatment. It should not be used in place of a professional consultation with a doctor.
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