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Pre-school wheeze fact sheet

Pre-school wheeze

What is pre-school wheeze?

Pre-school wheeze (also sometimes called reactive airways disease, viral-induced wheeze, multi-trigger wheeze or asthma) is an illness that occurs in children aged between one and five who have airways (breathing tubes) that are more sensitive than normal. It is very common for children to wheeze in their pre-school years, but most of these children will not develop asthma in later life.

Signs and symptoms

  • A high-pitched raspy sound or whistle when breathing out (wheeze)
  • Breathing quickly or finding it hard to breathe
  • Being able to see the muscles of the chest drawing in when breathing
  • Coughing

What causes it?

Wheezing can be triggered by environmental factors such as cold air, dust mites and cigarette smoke, which may make the airways narrow and inflamed (red and swollen), making it hard to breathe. The airways become narrow when the muscles in the airway walls tighten or there is a build-up of mucus.

How is pre-school wheeze diagnosed?

A doctor can usually diagnose pre-school wheeze based on the symptoms. Tests are not usually required.

What is the treatment?

Wheeze is usually treated with medication, which is inhaled via a puffer so it goes straight into the lungs.

Relievers

Puffer (e.g. salbutamol, Ventolin, Asmol)

  • opens the narrowed airways so that it is easier to breathe
  • works very quickly (in about four minutes) and last up to four hours
  • should only be used when your child has wheeze symptoms and not ‘just in case’
  • can be purchased without a prescription from your local pharmacy/chemist if you run out.

Preventers

Puffer (e.g. Flixotide) or tablets (e.g. Montelukast)

  • prevents wheezing episodes by treating the inflammation (redness and swelling) in the airways
  • only needed for a small number of children with pre-school wheeze. Your child’s GP or paediatrician will decide if preventers are needed (only available with a prescription).
  • if prescribed, should be taken every day even if your child feels well
  • your child should rinse their mouth thoroughly after use (as can cause oral thrush).

Steroids

Liquid medicine (e.g. prednisone, Redipred)

  • required for a small number of sick children depending on symptoms
  • your child’s doctor will decide if steroids are needed (only available on prescription)

How do I use a puffer?

Children should always use a spacer with puffer medication. A spacer is a cylinder-shaped device which reduces the amount of medicine that lands in the mouth and lets more go down into the lungs where it is needed.  Children who are unable to form a reliable seal around the spacer should also use a mask. For more information, see the factsheet on puffers and spacers.

Care at home

Your child’s doctor will prepare an Action Plan to help you manage your child’s wheeze at home. Keep your child’s Action Plan in a safe place so you can find it easily and quickly, and ensure it is shared with anyone who cares for your child e.g. relatives, other caregivers, day-care or kindergarten teachers.

If your child needs reliever medication more than every three hours, please see your doctor. Give your child the reliever and follow the Action Plan on your way to the doctor.

You should have a follow-up appointment with your GP after you leave hospital.

Key points to remember

  • Pre-school wheeze is managed with the same medications that are used for asthma.
  • Most pre-school children with wheeze will grow out of it and will not be diagnosed with asthma.
  • Make sure your child always has their medication and spacer (and mask if required) with them.
  • Follow the Action Plan prepared by your child’s doctor to manage your child’s wheeze.
  • Preventer medication should be taken every day as directed by your GP or paediatrician.

When to seek medical help

Wheezing episodes can be life-threatening. Please call 000 immediately if:

  • your child gets little or no improvement from the reliever medication
  • your child’s symptoms suddenly worsen
  • if you are alone and worried about being able to drive and monitor your child.

Otherwise, contact your local doctor or visit the emergency department of your nearest hospital. For non-urgent medical advice, call 13 HEALTH (13 43 25 84) to speak to a registered nurse 24 hours a day, seven days a week for the cost of a local call.

For more information

Asthma fact sheet | www.childrens.health.qld.gov.au/fact-sheet-asthma

Puffers and spacers fact sheet | www.childrens.health.qld.gov.au/fact-sheet-puffers-and-spacers

Educational asthma video series | www.childrens.health.qld.gov.au/wheeze-action-plan

National Asthma Council | www.nationalasthma.org.au

Asthma Queensland | www.asthmaaustralia.org.au/qld/home

Resource No: FS319 developed by Lady Cilento Children’s Hospital Emergency department.  Updated: June 2018. All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.

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