Post-discharge Viral Induced Wheeze (VIW)

Patient information leaflet

Viral induced wheeze care after your child leaves hospital

Overview

• This leaflet has been given to you as your child was treated in hospital for Viral Induced Wheeze (VIW).
• It will guide you on how to continue treating their viral wheeze once discharged.
• If you have any worries, concerns, or questions about your child, please make sure you ask the team before discharge or book an appointment with your GP.

What is Viral Induced Wheeze?

• Viral induced wheeze is a common condition that affects the airways, which are small tubes that carry air in and out of your lungs.
• Viral induced wheeze is when the tubes carrying air to the lungs (airways) become irritated and inflamed by a cold virus.
• This causes the tubes to swell and narrow making it more difficult for your child to breath.

What is the difference between ‘preventer’ and ‘reliever’ inhalers?

• There are many different types of inhalers.
• They are usually grouped into two types: “relievers” and “preventers.”
• Each type has different medicines that help your breathing in different ways.
• It is important to always use a spacer with an inhaler.
• A spacer is a plastic empty tube that slots over the inhaler at one end and has a mouthpiece on the other end.
• If you do not use a spacer with an inhaler, most of the medicine will not reach your lungs. This means it will not work properly.

Relievers

What do they do?

• Salbutamol (‘the blue inhaler’) is a medication used to relieve the symptoms of viral induced wheeze.
• It only helps when the symptoms of viral wheeze are present, it does not stop them happening.

How do they do it?

• Salbutamol is a ‘reliever’ medication.
• It works by relaxing a type of muscle in the airways called ‘smooth muscle’.
• This helps make the airways wider, relieving the symptoms of viral induced wheeze.

When are they used?

• Relievers are only needed when viral induced wheeze symptoms are present.
• They do not need to be used regularly if there are no symptoms.

Preventers

What do they do?

• ‘Preventer’ inhalers are prescribed for some children to prevent the symptoms of viral induced wheeze.
• They generally contain a steroid.

How do they do it?

• Preventors reduce the inflammation and mucus production in the lungs.
• This makes the airways less likely to become narrow.

When are they used?

• If prescribed, preventor inhalers must be used every day, even when there are no symptoms.
• If there are no symptoms when using a preventor, this means the preventor is working.
• If the preventor is not used regularly or the wrong technique is used, the symptoms could come back.

When to give your child Salbutamol after discharge

• If your child was treated with Salbutamol in hospital, they may need more once discharged.
• They will only need more Salbutamol if they have symptoms.

Symptoms to be aware of:

• Coughing
• Wheeze
• Chest Pain
• Tracheal Tug (Sucking in and out at the base of the neck)
• Chest Recessions (Sucking in and out in-between/ below the ribs)
• Nasal Flaring (Nostril moving in and out).

Fast breathing (respiratory) rate (number of breaths per minute)

• Count the number of breaths by looking at their chest and count how many times it moves up in 60 seconds.
• If the number is higher than the ‘acceptable respiratory rate’, they have a fast respiratory rate.

Flow chart

When to call 111 or take your child back to A&E

• If their symptoms return less than 4 hours after having Salbutamol or they need 6 puffs of Salbutamol, and their symptoms are still there.
• At any point, they look unusually exhausted, scared, have blue lips or mouth, or they are unable to talk in full sentences.
• In any of these situations, call 111 to ask for advice. Alternatively, take your child back to A&E.
• The concern is that your child’s viral wheeze may be worsening, and they may need additional treatment.
• If you are unable to get medical advice or bring your child to hospital quickly, call 999 for an ambulance.

GP Review within 48 hours (2 working days)

• Your child must see their GP within 48 hours (2 working days) of leaving hospital. This will need to be booked with the GP upon discharge.
• This is to make sure they are not at risk of another attack.
• This appointment is important to keep, even if they feel better or are back to their baseline.
• If their symptoms get worse before the GP appointment, or they cannot go 4 hours without using their Salbutamol (blue) inhaler, do not wait.
• You must call 111 or go to A&E straight away, even if the GP appointment is within the next 48 hours.

More information

Please visit the Ashma + Lung UK website https://www.asthmaandlung.org.uk/symptoms-tests-treatments/treatments or scan the QR codes below.

Contact our service

If you have any non-urgent questions, concerns or comments about your child’s viral wheeze, their treatment or the information you have been provided with, please call us on 020 7288 5231/5059 or email us at whittpaedasthma@nhs.net. We are available Monday to Friday 9am to 5pm. We will aim to respond to any emails within 48 hours.