# Preschool viral wheeze (episodic viral wheeze) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Pediatric Asthma - StatPearls (NCBI Bookshelf NBK551631) - https://www.ncbi.nlm.nih.gov/books/NBK551631/ · Egyptian National Drug Formulary - Respiratory System 2026 (salbutamol monograph) · Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-full.txt) · Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-clinical.txt) - Verified date: 2026-08 ## Verified against - Pediatric Asthma - StatPearls (NCBI Bookshelf NBK551631) - https://www.ncbi.nlm.nih.gov/books/NBK551631/ - Egyptian National Drug Formulary - Respiratory System 2026 (salbutamol monograph) - Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-full.txt) - Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-clinical.txt) ## Treatment metadata - Salbutamol — 0.1 mg — oral.inhalation - Referral & safety-netting (no drug therapy) - Prednisolone — 5 mg — oral.solid ## Complete treatment card ```text PRESCHOOL VIRAL WHEEZE (EPISODIC VIRAL WHEEZE) Sources: Pediatric Asthma - StatPearls (NCBI Bookshelf NBK551631) - https://www.ncbi.nlm.nih.gov/books/NBK551631/ · Egyptian National Drug Formulary - Respiratory System 2026 (salbutamol monograph) · Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-full.txt) · Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-clinical.txt) Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Cough is often the only presenting symptom and can be the sole clue to airway disease in a young child [cough] - A cough that is worse at night or triggered by cold air or exertion raises suspicion for reactive airway disease [cough · night-time symptoms] - A cough that lingers after a viral illness can be a clue to the diagnosis [cough] - In children this young, the recognized pattern is a recurrent cough worse at night, cough set off by laughing, crying, exercise, or smoke, and less activity than peers [cough · night-time symptoms] SIGNS - what you find (6) - The exam can be entirely normal between episodes - Between attacks, look for nasal discharge, reduced air entry or wheeze, inflamed nasal mucosa, allergic shiners, a transverse nasal crease, sinus tenderness, bad breath, eczema, and nasal polyps [nasal polyps · reduced air entry · runny nose · wheeze] - During an acute episode look for fast breathing, low oxygen, wheeze, prolonged exhalation, and accessory muscle use such as subcostal, intercostal, or supraclavicular retractions [chest recession · tachypnoea · wheeze] - Nasal flaring, a tripod posture, inability to speak in full sentences, or grunting are other signs of an acute episode [chest recession] - A child who was working hard to breathe but then quiets down, breathes at a normal rate, grows lethargic, or stops wheezing may be tiring toward respiratory failure rather than improving [lethargy · wheeze] - Altered consciousness, unresponsiveness, blue color, or a silent chest signal impending respiratory arrest TESTS (7) - In children this age, diagnosis rests on the symptom pattern, family history, and exam rather than any single test - Improvement with a 2- to 3-month steroid-inhaler trial supports the diagnosis, as does relapse after stopping it - Targeted allergy testing can guide avoidance of triggers such as pets, mold, cockroaches, or dust mites - A chest x-ray is only needed if the child fails to improve with treatment or another diagnosis is suspected - A sweat chloride test should be considered for recurrent chest infections, foul-smelling stools, malabsorption, or failure to thrive - An acute wheezing episode is a clinical diagnosis and does not routinely need labs or imaging - During an acute episode, a chest x-ray is reserved for asymmetric findings, chest pain, unexplained fever, treatment failure, or a critically ill child IF NOT THIS - what else fits (4) - Upper-airway disease such as allergic rhinitis and sinusitis can mimic the picture - Large-airway obstruction from a foreign body, vascular ring or laryngeal web, laryngomalacia, tracheomalacia, lymphadenopathy, a mass, epiglottitis, or vocal cord dysfunction needs to be excluded - Small-airway causes such as viral bronchiolitis, cystic fibrosis, primary ciliary dyskinesia, and bronchopulmonary dysplasia belong on the list, and are especially relevant at this age - Other mimics include congestive heart failure, reflux disease, anaphylaxis, angioedema, adult- onset COPD, cardiomegaly, immunodeficiency, pulmonary edema, recurrent aspiration, an embolism, and atypical mycoplasma infection Source StatPearls "Pediatric Asthma" - disease-level clinical article Status traced to the source above 1. SALBUTAMOL [1st line] Adult Not applicable - preschool viral wheeze is by definition a condition of children under 6 (see paediatric dosing) - As needed during an episode; reassess if needed more than twice a week Peds Home or rescue use: 2 to 4 puffs from a salbutamol MDI, or a nebulised 1.25 to 2.5 mg for a child of 4 years or under and 2.5 to 5 mg for one aged 4 to 11. At the start of an exacerbation give the rescue dose and repeat it 20 minutes later. In the clinic: up to 3 doses of a larger amount over 1 hour - 4 to 8 puffs from the MDI, or by nebuliser 2.5 mg to 5 mg. Source Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool- viral-wheeze-full.txt) Why Indication and dose from the same disease-level article, which covers exactly this group: children whose symptoms come and go, set off as a rule by viral infection, and who tend to grow out of the episodes. Its first step is that every wheezing child should be able to use a short-acting beta-agonist, the sole exception being an infant of 1 year or under whose wheeze is from bronchiolitis. The dose is stated in the same document (see paediatric note). Named Salbutamol because that is the Egyptian register's spelling of the drug the article calls albuterol. Caution SPACER, ALWAYS - a child of 5 or under takes a pressurised metered-dose inhaler through a valved spacer, and at the younger end through a face mask as well. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) An MDI fired into a preschooler's mouth delivers almost nothing. WHEN TO STOP WAITING AT HOME - a child who responds well to the reliever, and whose symptoms have not come back within 4 hours, can stay at home, taking it every 4 to 6 hours if needed. One who does not respond fully takes a third rescue dose, and medical advice is sought. NOT FOR BRONCHIOLITIS - the article's stated exception is the infant of 1 year or under whose wheeze is bronchiolitis. ESCALATION TRIGGER - a child needing the reliever more than twice a week, over 1 month, moves up to step 2. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) Step 2 is a daily low-dose inhaled steroid; the article states no dose for it, so none is printed here - that is a referral or a paediatric-asthma decision, not a number invented for it. RISK MARKER - getting through more than 1 salbutamol inhaler a month is on the article's list of things that raise the risk of an attack. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) A family refilling monthly is not controlled. THE EGYPTIAN FORMULARY DISAGREES ON THE CEILING and the disagreement is real: its salbutamol monograph gives, for a child under 12 years, one inhalation of 100 mcg, or two inhalations, given up to 4 times a day, the daily dose must not exceed 800 mcg, and must not exceed 6 doses in 24 hours. The article's acute-rescue figures (4 to 8 puffs, up to 3 times in an hour) exceed that ceiling. The formulary's figure is a maintenance ceiling; the article's is an exacerbation regimen. Use the higher figures only for an acute episode, under review, not as regular dosing. The Egyptian formulary also notes that under 4 years another pharmaceutical form may suit better - i.e. nebuliser or MDI-plus-spacer-and-mask rather than a bare inhaler. Contra-indication (Egyptian formulary): hypersensitivity to salbutamol, or to any component of the preparation. Expect tremor and jitteriness: the formulary lists excitement (children, adolescents: 2% to 20%), nervousness (4% to 15%) and tremor (5% to 38%). The article notes that repeated doses lower the serum potassium, phosphate and magnesium, and raise the glucose. Egypt AEROLIN 100MCG/DOSE INHALER EIPICO > 3M H... 7.30 EGP BUTALIN 100MCG/ACTUATION 200 DOSES JULPHAR 12.00 EGP VENTAL INHALER 100 MCG/DOSE 200 DOSES ARAB DRUG COMPANY (ADCO) 72.00 EGP VIASALMOL 100MCG 200 ACTUATION INHALER MDI PHARMA 72.00 EGP VENTOLIN EVOHALER 100MCG/ACTUATION INHALER GLAXO SMITHKLINE 86.00 EGP OPICHESTAL SYRUP 120ML EL-OBOUR 2.00 EGP -> ? strength differs, ? different route - not oral.inhalation SALBUTAMOL 2MG/5ML SYRUP 120ML SEDICO 3.50 EGP -> ? strength differs, ? different route - not oral.inhalation 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool- viral-wheeze-clinical.txt) Why Carries the escalation and safety-netting the article states, which apply whichever reliever the family has. Caution RED FLAG - a child who does not respond fully takes a third rescue dose, and medical advice is sought. A child still working to breathe after three doses in an hour needs to be seen, not re-dosed at home. REFER - step 3 doubles the starting dose of the inhaled steroid for 3 months; where symptoms persist despite that, refer to an asthma specialist. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) BEFORE ESCALATING, CHECK THE BASICS - where control is poor, first rule out a different diagnosis, check the medicine is actually being taken, watch the inhaler technique, and ask about tobacco smoke and allergens at home. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) In practice the commonest cause of failure is technique, not dose. SMOKE - keeping the child away from what sets the asthma off matters: tobacco smoke, first-hand or second-hand, triggers among foods and medicines, and pollutants and irritants generally. Ask who smokes at home; say it every visit. TEACH THE DEVICE - the patient and the carer must have the inhaler technique right, and must know which inhaler is the reliever, which the controller, and which does both. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) Watch the parent use the spacer before they leave. PROGNOSIS TO GIVE THE FAMILY - the episodic pattern tends to do better in adult life, and the article puts at 30% to 70% the proportion of asthmatic children who improve markedly, or lose their symptoms altogether, by early adulthood. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) Write an action plan - one shaped to the individual child and to how well controlled the asthma is, so the family has a set way to handle a flare and to adjust treatment. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) 3. PREDNISOLONE [2nd line] Adult Not applicable - preschool viral wheeze is a condition of children under 6 (see paediatric dosing) x 3 to 5 days Peds 1-2 mg/kg/day [child max 20 mg] (1 to 2 mg/kg/day for 3 to 5 days. The article's ceilings are age- specific: maximum 20 mg/day in children aged 0 to 2, 30 mg/day aged 3 to 5, 40 mg/day aged 6 to 11. The calculator above applies the LOWEST stated ceiling (20 mg) so it can never over-dose the youngest child; for a 3-5 year old the article permits up to 30 mg/day.) 3kg -> 3-6 mg/day 4kg -> 4-8 mg/day 5kg -> 5-10 mg/day 6kg -> 6-12 mg/day 7kg -> 7-14 mg/day 8kg -> 8-16 mg/day 9kg -> 9-18 mg/day 10kg -> 10-20 mg/day 11kg -> 11-20 mg/day (upper capped) 12kg -> 12-20 mg/day (upper capped) 13kg -> 13-20 mg/day (upper capped) 14kg -> 14-20 mg/day (upper capped) 15kg -> 15-20 mg/day (upper capped) 16kg -> 16-20 mg/day (upper capped) 17kg -> 17-20 mg/day (upper capped) 18kg -> 18-20 mg/day (upper capped) 19kg -> 19-20 mg/day (upper capped) 20kg -> 20 mg/day (capped) 21kg -> 20 mg/day (capped) 22kg -> 20 mg/day (capped) 23kg -> 20 mg/day (capped) 24kg -> 20 mg/day (capped) 25kg -> 20 mg/day (capped) 26kg -> 20 mg/day (capped) 27kg -> 20 mg/day (capped) 28kg -> 20 mg/day (capped) 29kg -> 20 mg/day (capped) 30kg -> 20 mg/day (capped) 31kg -> 20 mg/day (capped) 32kg -> 20 mg/day (capped) 33kg -> 20 mg/day (capped) 34kg -> 20 mg/day (capped) 35kg -> 20 mg/day (capped) 36kg -> 20 mg/day (capped) 37kg -> 20 mg/day (capped) 38kg -> 20 mg/day (capped) 39kg -> 20 mg/day (capped) 40kg -> 20 mg/day (capped) 41kg -> 20 mg/day (capped) 42kg -> 20 mg/day (capped) 43kg -> 20 mg/day (capped) 44kg -> 20 mg/day (capped) 45kg -> 20 mg/day (capped) 46kg -> 20 mg/day (capped) 47kg -> 20 mg/day (capped) 48kg -> 20 mg/day (capped) 49kg -> 20 mg/day (capped) 50kg -> 20 mg/day (capped) Source Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool- viral-wheeze-full.txt) Why Indication and dose in the same article. It has a child of 6 to 11 with severe symptoms starting an oral corticosteroid soon after the reliever is begun, and gives the amount as 1 to 2 mg/kg/d of prednisone or prednisolone, capped by age: 20 mg/d from 0 to 2 years, 30 mg/d from 3 to 5, and 40 mg/d from 6 to 11. The course is 3 to 5 days. The article prints per-age ceilings for ages 0-2 and 3-5, which is why oral prednisolone is offered for preschoolers - but only as a clinician decision (see the first caution). Line 2: the reliever comes first. Caution CLINICIAN-INITIATED ONLY IN THIS AGE GROUP - the guidelines, the article says, do not back a carer giving oral steroids to a child of 5 or under. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) Do not hand a preschooler's family a standby course to start at home. Give it AFTER starting the reliever, not instead of it - the oral steroid follows soon after the reliever has been begun. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) Short course only - 3 to 5 days. No taper is stated for a course this short. A preschooler needing oral steroids has had a significant episode; arrange review rather than repeating courses. Repeated courses are a reason to reassess the diagnosis and refer. Avoid in a child with active varicella or a systemic fungal infection, and check for recent chickenpox exposure before a course. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)