GP FAQ preschool wheeze
Wheeze is a common symptom, however, it may be mistaken for other sounds such as stridor, snoring or congestion. Ask parents to describe what they are actually hearing, a video of the child when the parent hears the noise can be helpful.
There are two main types of wheeze in young children:
Episodic viral wheeze (EVW) – in association with clinical evidence of a viral upper respiratory tract infection, with no wheeze in between viral episodes.
Multi-trigger wheeze (MTW) – this is wheezing with discrete exacerbations but also symptoms in between episodes. Triggers might include: viral infection (most common), tobacco smoke, allergen exposure, mist, exercise etc.
There are many risk factors for MTW wheeze:
- Early onset of allergies
- Previous admission to hospital with wheeze
- RSV/RV bronchiolitis
- Family history of asthma
- Method of infant feeding (duration of breastfeeding)
- Blood eosinophilia levels (≥300/mm3)
What is the role of steroid treatment in wheeze episodes?
Steroid treatment is not recommended for children with episodic wheeze. Oral steroids do not decrease the length of hospital admission or reduce symptom severity in viral induced wheeze. However, oral steroids may have a place in the management of pre-school children presenting to A&E with wheeze and a history of atopy or multiple-trigger wheeze.
References:
J Panickar et al, Oral Prednisolone for Preschool Children with Acute Virus-Induced Wheezing, N Engl J Med 2DOI: 10.1056/NEJMoa0804897009; 360:329-338, DOI: 10.1056/NEJMoa0804897
Abrams, Elissa M. et al, Use of Oral Corticosteroids in the Wheezy Toddler, The Journal of Pediatrics, Volume 201, 16 – 20, DOI: https://doi.org/10.1016/j.jpeds.2018.06.011
