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.

Treatment

Over the next few days you should assess your child at least every 4 hours to make sure that they  are recovering from their attack of wheezing.

This is particularly important at night and first thing in the morning.

If they are breathless or wheezy

  • Give 2 puffs of blue inhaler one at a time using a spacer. Review their response after 10 minutes. If they are not improving give another 2 puffs and reassess. If they are still not getting better, repeat up to a maximum total dose of 10 puffs and reassess.
  • If you are still worried after this: Give up to another 10 puffs of blue inhaler one at a time using a spacer. Seek urgent help by calling 999 or attend your local Emergency Department

If they are not breathless or wheezy

  • They do not need their blue inhaler. Continue to review them at least every 4 hours.

If your child has any of the following:

  • Breathing very fast, too breathless to talk, eat or drink
  • Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
  • Breathing that stops or pauses
  • A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)
  • Is pale, blue, mottled or feels unusually cold to touch
  • Difficult to wake up, very sleepy or confused
  • Weak, high-pitched cry or can’t be settled
  • Has a fit (seizure)
  • Has a rash that does not go away with pressure (the ‘Glass Test’)
  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features)
Ring 999 for immediate help.

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

Keep child in upright position and reassure them.

If your child has any of the following:

  • Breathing a bit faster than normal or working a bit harder to breathe
  • A harsh noise as they breathe in (stridor) only when upset
  • Dry skin, lips or tongue
  • Not had a wee or wet nappy in last 8 hours
  • Poor feeding in babies (less than half of their usual amount)
  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
  • Is 3 to 6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
  • Temperature less than 36°C in those over 3 months
  • Getting worse and I am still worried

Please call your GP surgery or call NHS 111 - dial 111

If your child has a salbutamol (blue) inhaler please follow your treatment plan

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features

 

Watch them closely for any change and look out for any red or amber symptoms

If your child has any other symptoms associated with their fever, you may want to look at the information on sore throatcoughearachediarrhoea and vomiting or tummy ache or our other pathways.

Continue providing your child’s care at home. If you are still concerned about your baby, speak to your health visitorlocal pharmacist or call NHS 111– dial 111

For parents from ethnic minority groups, you can contact the Barnado's Boloh advisors who can provide practical advice and support in many different languages. Call 0800 151 2605 or click here for the web chat function.

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 goo.gl/235DQf

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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