Is it ‘Asthma’? Or a ‘viral wheeze’?

Many children present to their GPs or come to A&E with difficulty in breathing and are given inhalers / nebulisers, which sometimes make them better. The medicines that are used in the inhaler is usually Salbutamol (Ventolin), Ipratropium (Atrovent) etc. They sometimes get Prednisolone orally as well, which is a steroid.

A very common question asked is, ‘Does my child have Asthma’? Or is it a ‘Viral wheeze’?Not a straightforward answer, unfortunately. It takes a lot of medical training & experience to be close to the correct answer, but broadly, it’s more likely to be Asthma in following situations

  1. Multiple ‘Wheezy’ episodes (>4-5)
  2. History of Asthma/Eczema/Food allergies/Hay fever/ in family (Atopy)
  3. Age > 2 years, we usually don’t diagnose Asthma under 2 years of age.
  4. Induction of wheeziness, without a preceding ‘viral illness / cold’
  5. Long time to recovery, usually better with ‘Steroids’.
  6. Hospital stay  > 1-2 days
  7. Previous Paediatric Intensive care admission etc.

Lung function tests are tricky in children specially < 5-6 years as they are not keen to blow in the machine (specially when asked to!)

Luckily, treatment is pretty much the same. Except, we usually avoid giving steroids in Viral wheeze. But sometimes we do, if the child is appearing too unwell.

Hope this helps!!

Author: ramnikmathur

Private Paediatrician and specialist in allergies

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