Viral wheeze


What is viral wheeze in children?

The air we inhale enters the lungs through tubes called bronchi. These tubes are small in diameter in infants and toddlers, and can easily become blocked. Some viruses that children catch, cause narrowing of these tubes. The result is wheeze, a loud, harsh, high-pitched respiratory sound, which can be heard with or even without a stethoscope.

What is the cause of viral wheeze?

There are many viruses that can affect a toddler’s breathing in the above way. More rarely, this happens when the child is exposed to cold, or humidity, or bacteria, or as an allergic reaction to food.

How is viral wheeze manifested?

The child usually has symptoms of a virus: light fever, runny nose, coughing. The cough is persistent, dry, and bothers the child before or during sleep. In more serious cases, the child breathes quickly, or with difficulty, and becomes tired from the effort, or will vomit.

How is it different from asthma?

Viral wheeze does not necessarily mean asthma. It is a single episode, while asthma is a chronic disease.

Many toddlers tend to be affected by viral wheeze, when suffering from viruses, due to their small bronchi. Most children of school age, having more developed bronchi, don’t have further episodes. Some children – in particular those with a history of allergies, those with a history of allergy in the family, those who did not breastfeed, who suffered from wheeze during early childhood, and those who had severe and frequent episodes – develop asthma later on.

How is it different from bronchiolitis?

Bronchiolitis is usually a disease of infants up to two years old. It, too, is caused by viruses, and it makes breathing difficult, but the clinical picture is different, and the child has crepitations.

How is viral bronchospasm treated?

Antibiotics should not be administered – viruses don’t respond to antibiotics, and they can cause side effects.

The main medications are of two kinds:

Bronchodilators (Aerolin, Atrovent, Berovent)

These are always administered with aerochamber inhalations and a mask. They relieve the problem for a few hours by opening the bronchi.

The dose is generally 3 inhalations of Aerolin, 3-4 times a day.

Dosage is adjusted according to the clinical picture of the child. If the child has difficulty breathing, he can take up to 6 inhalations each time, every four hours. It is important for the treatment to be continued during the night, when the situation is usually worse. If you are still concerned about the child, even while taking maximum doses, contact the paediatrician. If the child improves, spread out doses proportionally, until they can be stopped, usually in a few days or weeks.

Anti-inflammatory medications (inhaled steroids, steroids by mouth, Singulair)

These act more slowly, by stopping the inflammation, and unblocking the bronchi. The doctor will decide which medication is appropriate each time, and for how long it should be taken.

How can we prevent new episodes of viral bronchospasm?

Good nutrition, careful hygiene, and washing of the child’s hands will help. It isn’t always possible to prevent these episodes, since viruses are very frequent in children. Anti-inflammatory medications, when administered on a chronic basis, prevent new episodes (resulting in the occurrence of increasingly less severe episodes).

It is important that the child gets all the necessary vaccines.

When should I worry?

Promptly contact your paediatrician if the child:

  • Has a high fever, which does not fall easily
  • Isn’t eating well ( less than 50% of the usual quantity, or is vomiting)
  • Seems lethargic or extremely restless
  • Is breathing very quickly, or has difficulty breathing
  • The maximum dose of Aerolin has no result
  • There are new symptoms that have appeared since the paediatrician last saw the child.


Stelios Papaventsis Paediatrician MRCPCH DCH IBCLC 2011

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