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Wheeze in 1-5 year olds – Preschool Asthma

Wheeze in young children

Between the ages of 12 months and 5 years many toddlers and young children will experience ‘wheeze’ associated with a cough and runny nose. This is similar to asthma and responds to asthma treatment which involves giving ventolin given via a spacer device and mask. Occasionally some toddlers will require preventative medication. Hospitalisation is sometimes needed if oxygen is required.

What causes the wheeze ?

A simple cold virus, will interact with the smaller airways of toddlers, resulting in inflammation. This leads to the formation of tiny bubbles. When breathing air in and out, these bubbles burst and reform, much like the squeezing of a wet sponge. This is wheezing. If there is a large amount of inflammation (similar to a wet sponge), there will be increased work of breathing. This condition can occurs in up to 30% of children.’

Is this asthma ?

This condition is called preschool asthma. However many children will grow out of this by the time they are 5-6 years of age. Asthma continuing into primary school will usually occur in children who have other asthma triggers. These include allergies, exercise, changes in weather and even emotion. For daycare’s and early childhood, calling it asthma is acceptable and using an ‘asthma management plan’ is appropriate.

How to treat wheeze in toddlers

Wheeze in young children

Treatment involves opening the airways with ventolin which is given by a mask and spacer device (see pic). The technique is important to ensure a tight seal around the face. This sometimes requires a firm hold which can be frustrating for parents when dealing with a fractious toddler. See Royal Childrens Asthma Videos for some tips on how to correctly use the mask and spacer. Make sure the mask is of good quality (silicon) and the spacer is the small type.  The dose of ventolin tends to be between 3 – 6 puffs. Each puff delivered separately with 3-5 breaths between each puff. Frequency and amount of ventolin given depends on the severity and is indicated in the table below.

Assessing wheeze and cough

The toddler or child will start coughing when suffering from a cold. The cough will sound slightly moist and initially breathing will be unaffected. However in some instances there will be shortness of breath. This is assessed by carefully watching the breathing. Assess the effort involved in breathing and use exercise as an analogy. So a mild increase in chest movement is similar to someone walking, moderate is how someone’s breathing looks when jogging and severe is what someone looks like who has just been sprinting. The table below summarises this. 

How to assess and manage wheeze
Severity Assessment of wheezeTreatment – using ventolin administered by maskOngoing treatment
MildThe breathing appears similar to walking – your child will be comfortable, but there maybe a slight increase in rate of breathing and effort. Talking is still easy without pauses for breaths. Give ventolin, 4 puffs, every 3-5 hours depending on response and whether there is improvement or deterioationAs the wheeze and cough disappears the ventolin use can be weaned. If still slight cough, then continue two puffs of ventolin twice per day
ModerateBreathing appears similar to Jogging – your child will still be comfortable, but the chest is moving more than usual and talking requires pauses for breaths. Give ventolin 6 puffs initially every 1-2 hours. If improvement noted move to mild treatment. If deterioation then move to severe treatment and seek urgent medical helpContine to use ventolin frequently. If there is limited response sometimes prednisolone is required to help with the inflammation. Seek medical advice if treatment appears to be not working.
SevereBreathing appears similar to Running – your child is clearly short of breath, talking is difficult and there is considerable effort with each breath.Give 6 puffs of ventolin. This can be given quite frequently (every 20 minutes)  and urgently seek medical help. Do not hesitate to call an ambulance.Severe attacks that result in hospitalisation often require preventative treatments. These are safe and effective and lessen the severity and amount of medication required.

What preventatives are useful ?

  • Flixotide – This is an inhaler to be used with a spacer and contains a low strength inhaled steroid. This is extremely safe and effective when used as directed. It can take a 2-3 weeks to work. The usual dose is one puff twice per day but sometimes two puffs twice per day are needed. 
  • Singulair – This chewable tablet can be given to toddlers over the age of two years. Unfortunately there is a rare but definite association with behaviour problems in some children and currently has a warning attached. It works to block some of the inflammatory chemicals released by the airways in response to the virus. It is not a steroid.  It is generally used as an additional treatment to flixotide in those who have quite severe or persistent asthma. 

Some Facts about wheezy toddlers.

  • If your child has wheezing in response to exercise, changes in temperature, allergens such as dust mite, it is more likely to result in longer term asthma. 
  • Sometimes recurrent episodes need to be prevented. The primary preventer recommended is an inhaler called flixotide. 
  • Influenza A is a common trigger for particularly severe episodes, so annual vaccination is strongly recommended.
  • Passive smoking will certainly contribute to this condition.
  • Ventolin syrup has no effect on wheezy toddlers.
  • Beware of alternative treatments and their claims. There is no evidence that wheat and dairy have any role in viral induced wheeze.

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