My child and virus induced wheeze

Who is this document for?

This information is for parents or guardians whose child has attended the emergency department or been admitted to hospital after an episode of virus or infection induced wheeze.

What is virus induced wheeze?

A wheeze is a high pitched musical noise heard when a child breathes out.

Wheeze caused by an infection or virus is a common condition in childhood and occurs when a cough, cold or chest infection irritates the breathing tubes that carry air in and out of the lungs. Virus induced wheeze is most common in children of pre-school age. One in three children will have had an episode by the time they are three years old. This may occur each time the child has a cold virus, but yet they are normally well and symptom free when they don’t have a cold. If your child was born early, has had bronchiolitis or is exposed to cigarette smoke they are more likely to have episodes of virus induced wheeze.

What happens to my child’s body during an episode of virus induced wheeze?

During an episode, the airways become irritated by an infection or virus. The muscles around the airways tighten and the airways produce extra mucus, causing the breathing (bronchial) tubes to narrow. During an episode, your child may cough, wheeze (a high pitched whistle or musical noise) and have trouble breathing.

Does my child have asthma?

Virus induced wheeze is similar but different to asthma. Some children with episodes of wheeze may go on to develop asthma. Children with asthma have symptoms in-between colds or chest infections. If your child or their siblings/ parents have had eczema, food allergies or hay fever, they are more likely to have asthma.

What care will be given to my child during their time in hospital?

Your child will be seen by a children’s nurse and doctor who will look at the seriousness of their symptoms and check how they are.

Here are some of the common tests or treatment they might receive, or may have received:

• A test to measure your child’s heart rate and oxygen level using a finger probe.
• Listen to your child’s lung sounds with a stethoscope.
• Measurement of your child’s height and weight.
• Oxygen will be given if needed, via a face mask or nasal prongs.
• Nebulised (misty) medication via a face mask.
• Inhaled medication via a blue inhaler ('puffer') and spacer.
• A test to identify how well your child’s lungs are working – which might include a peak flow test if your child is five years old or older.

You will also be asked for details about your child and their history of breathing illness or wheeze.

What medicine will be given?

Reliever medications

These are medicines such as salbutamol which can be given with a blue inhaler and spacer or a nebuliser. They work by relaxing the tightened muscles around the breathing tubes and help the airways to open wider. This makes it easier to breathe.

A spacer is used to help deliver medicine into the lungs, and it is the best way to give your child medicine from their inhaler (puffer). It has a mouthpiece or mask on one end and a hole for the inhaler at the other. Research shows using a spacer works as well as nebulisers in most episodes of virus induced wheeze. In this hospital we use Aerochamber spacers.

A nebuliser creates a mist of medicine that is then breathed in through a mask. Nebulisers can deliver higher doses of medication and are used if your child needs oxygen at the same time.

Steroids

Your child might be given a short (three day) course of steroids either in liquid or tablet form to help bring their viral wheeze under control more quickly.

Antibiotics

Your child might be given a course of antibiotics taken by mouth, especially if they have a wet cough, a fever or if the doctors can hear sounds of infection in the lungs when listening to your child’s breathing.

When can I go home?

As your child begins to recover we can increase the time (interval) between salbutamol (blue inhaler) doses normally from 1 to 4 hours. As soon as your child can cope with a four-hour interval between their next dose of salbutamol (blue inhaler) without having symptoms, that is a good indicator that they are about ready to go home.

In addition, before you go home:

• Your child will be reviewed by a doctor including an assessment of what medicines your child is taking.
• A nurse will check your child’s inhaler technique.
• A nurse will give you a viral wheeze action plan.
• Your child’s trigger will be identified.
• A nurse or doctor will also make sure you have the correct follow up arranged in a children’s outpatient’s clinic.

Your child will be seen by the children’s asthma nurse specialist or they may contact you by telephone over the next few days if your child:

• has had several episodes of virus induced wheeze
• has eczema, food allergies, or hayfever
• finds it very difficult or upsetting to use their inhalers

What shall I do when we get home?

After your child has had an episode of wheeze, it is important that they rest as much as they need to. Children normally feel quite tired after an episode of wheeze, and if they needed to stay in hospital this may have unsettled them.

Make an appointment for your child to be seen by their GP in two days’ time, so they can listen to your child’s lungs and make sure they are recovering well.

When can my child go back to nursery or school?

As soon as your child is back to their normal self they can go back to nursery or school. It is important to remember that your child might need some salbutamol (blue inhaler) if they have any symptoms over the next few days. Check with the nursery or school that they are able to support you and your child with this.

How can I prevent this from happening again?

• Immediately after your child’s admission, arrange a review with your GP in two days.
• Follow your child’s post asthma attack symptom management plan.
• Exercise good handwashing techniques to help prevent the spread of colds and viruses.
• Know your child’s viral wheeze action plan and keep it accessible on your mobile phone or in their nursery/ school bag as well as somewhere visible at home.
• As soon as your child develops a cold or virus, give your child salbutamol via a if they have symptoms of cough, wheeze or breathlessness. Please refer to your viral wheeze action plan.

When to contact your GP or the children’s asthma nurse specialist

Contact your GP or the children’s asthma nurse specialist if your child:

• needs salbutamol (blue inhaler) more than two times a week
• has a night-time cough
• has symptoms that stop them doing the things they enjoy
• has a further episode, even if they feel better already

What should I do if this happens again?

If your child begins to develop similar symptoms such as cough, wheeze or breathlessness, refer to their virus wheeze action plan.

What about smoking?

Children who are exposed to other peoples’ cigarette smoke are known as ‘passive smokers’. Passive smokers are more likely to have episodes of wheeze, and are more likely to develop asthma, increasing the risk of wheeze related death. Passive smoking exposure reduces the effectiveness of inhaled medications.

Research shows that even when household members smoke away from the child, as the by-products of smoking cling to breath and clothing we can still find indicators of passive smoking in children’s urine.

The best thing you can do for your own health and the health of other members of your household is to stop smoking. As this may be a very difficult thing for you to do, the best way to stop smoking for life is to seek help and support from your GP’s smoking cessation service.