Viral induced wheeze

• What is viral-induced wheeze?


  Acute wheezy illness caused by a viral infection

  Typically affects small children < 3 yrs (due to small airways)
• Why does viral-induced wheeze affect small children more than adults?

  Small children have narrower airways

  So, even slight narrowing causes a large restriction in airflow compared to adults
• What are the common causes of viral-induced wheeze?

  RSV

  Rhinovirus

  COVID

  Parainfluenza

  Influenza
• What are the key differences between viral-induced wheeze & asthma?


  VIW

  • occurs < 3 yrs
  • no atopic Hx
  • wheeze only during viral infections (no interval symptoms)

  Asthma

  • has additional triggers (exercise, cold, dust & emotions)
  • will have interval symptoms in between infection
• What should you suspect if you hear a focal wheeze in a child?

  Inhaled foreign body OR tumour

  Requires urgent senior review
• What are the signs & symptoms of viral-induced wheeze?


  Evidence of viral illness 1-2 days preceding -> fever, cough, coryzal symptoms

  SOB

  Increased work of breathing

  Expiratory wheeze throughout whole chest
• What is the management of viral-induced wheeze?

  Combined nebs (salbutamol + ipratropium)

  High flow O2

  Steroids

  Magnesium (if nothing else is working)
• What is important to ask about in viral-induced wheeze?


  Any prior episodes?

  Prior admissions?

  Trips to ITU?

  Ever needed IV therapy?

  Steroids given previously?

  FHx of atopy?

  Do they use inhalers at home? How often? -> check inhaler technique

  Explore triggers?
• What are the Inx of VIW?


  Obs

  Full Hx & examination

  CBG

  Viral swabs