Viral Induced Wheeze

Quick Ref Guide


  • Viral respiratory infections are the most common cause of wheezing in infants and young children
  • Risk factors include exposure to tobacco smoke and reduced lung function
  • Although treatment is broadly like treatment for asthma there are some differences

Clinical Presentation

  • Usually history runny nose, cough, intermittent fever then wheeze
  • Only get wheezy with colds – no interval symptoms
  • Examination – nasal congestion, tachypnoea, increased work of breathing and polyphonic wheeze.
  • Assess for level of dehydration caused by tachypnoea, fever, decreased oral intake

What to do

  • Assess severity:
  • Hypoxia (<92%): give oxygenimmediately
  • Life threatening: move to Resus and call for paediatric support – treat as BTS life threatening asthma
  • Severe: use nebulised salbutamolin all age groups except under 6 months – refer to paediatrics
  • Mild/Moderate: use inhaled salbutamol. If good response – can be discharged with viral wheeze plan (available on intranet). If poor response – consider treating as severe with nebulised bronchodilators

Other medications

  • Ipratropium bromide– No evidence this is superior to salbutamol under 1 year – however can be added if no response to salbutamol
  • Steroids– no evidence they reduce length of illness in mild to moderate casese – restrict to those who are very unwell and likely to need intensive care
  • Antibiotics are not routinely used. However if indicated for suspected secondary bacterial infection / atypical pneumonia – Azithromycin is recommended for 3 days
  • Prophylaxic Steroids – there is no strong evidence for any prophylaxis. High dose intermittent inhaled steroids has shown some improvement but cumulative dose risk outweighs benefits
  • Montelukast – a small subgroup benefit and therefore trial may be appropriate


  • Complete Episodic Wheeze Plan
  • Give advice sheet



Guidance for the treatment of Episodic Viral Wheeze in Children (June 2018)


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