Personal Viral Induced Wheeze Action Plan

What is viral induced wheeze?

A wheeze or whistling sound that is caused by a viral infection (a cough or a cold). The wheeze may return each time your child has a cold. Usually the child is well in-between the viral infections but the wheeze can last for some weeks after the infection. Children under the age of 3 years are more likely to be affected as their air passages are small.


Over the next few days, your child will need to be regularly given a blue (salbutamol) reliever inhaler.

Dose of blue (salbutamol) reliever inhaler via Spacer:

Today ....... puffs, ....... hourly for first ....... day(s)

Then ....... puffs, ....... hourly for next ....... day(s)

Then ....... puffs, ....... hourly until symptoms improve

after which your child should be back to normal and you should be able to stop the blue inhaler.

In the event that your child has been started on steroid tablets, these should be continued once daily (usual treatment course is 3 days).

If your child becomes increasingly breathless despite following the plan above, you should follow the instructions outlined in the table below

Looking after your child during episodes of viral induced wheeze

At the start of cold symptoms (such as runny nose), begin your child on blue (salbutamol) reliever inhaler 2 puffs 4 hourly (including through the night).

If you / your child is:

  • Too breathless to talk / eat or drink
  • Has blue lips
  • Having symptoms of cough/wheeze or breathlessness which are getting worse despite treatment
  • Confused and drowsy
Ring 999 for immediate help.

Give 10 puffs of blue (salbutamol) reliever inhaler every 10 minutes until ambulance arrives.

Keep child in upright position and reassure them.

If you / your child is:

  • Wheezing and breathless and the reliever treatment is not lasting 4 hours
  • Having day-time and night-time symptoms of cough or wheeze
  • Too breathless to run and play

Immediately contact your GP and make an appointment for your child to be seen that day face to face.

Increase blue (salbutamol) reliever inhaler 6-10 puffs every 4 hours

If your child’s breathing is not laboured or fast and he/she is able to continue their normal day to day activities

Give 2-5 puffs blue (salbutamol) reliever inhaler every 4 hours until symptoms improve.

Standard technique for use of inhaler and spacer

Choose appropriate sized spacer with mask (or mouthpiece if child is over 3 years with good technique and is not significantly short of breath)

  1. Shake the inhaler well and remove cap
  2. Fit the inhaler into the opening at the end of the spacer
  3. Place mask over the child’s face ensuring a good seal
  4. Press the inhaler once and allow the child to take 5 slow tidal breaths between each dose
  5. Remove the inhaler and shake between every puff

Repeat steps 2 – 5 for subsequent doses

Plastic spacers should be washed before 1st use and every month as per manufacturer’s guidelines

For videos on using your child’s inhaler and spacer correctly see

Does this mean my child has asthma?

No, not necessarily. This is a different condition from asthma, although a few children do go on to develop asthma.

Children with asthma:

  • Are often wheezy, even when they do not have a cough or cold
  • Usually have a family history of asthma and allergy
  • Are generally more breathless than their friends when they run around or become wheezy on exercise.
  • Often have a regular night time cough

If you are worried that your child has asthma, you should make an appointment to see your GP or GP asthma nurse.

Follow up

Although your child has not been diagnosed with asthma, your GP asthma nurse will usually be happy to review children with viral induced wheeze. If your child has been discharged from hospital, you should arrange for them to be seen in the next 48 hours by your GP or GP practice nurse. You should arrange for them to be reviewed by your GP if they continue to have lots of problems with wheeze once they have recovered from their cold.

This guidance is written by healthcare professionals from across Hampshire, Dorset and the Isle of Wight.

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