Asthma, Wheeze & Long-Term Respiratory Care
Separate acute severity from long-term control and support effective inhaled treatment.
Quick revision ↓ Medical Dictionary
01Establish the pattern
Ask about recurrent wheeze, cough, exercise symptoms, night waking, triggers and atopy. Not every wheezing preschool child has established asthma. Use age-appropriate objective testing where feasible and consider alternative diagnoses when symptoms are atypical or response to treatment is poor.
02Acute assessment
Assess speech or feeding, respiratory effort, oxygenation and exhaustion. A silent chest with distress can signal severe airflow limitation rather than improvement. Treat according to the acute paediatric asthma pathway, using age-appropriate delivery devices and prompt escalation when response is inadequate.
03Controller treatment
Long-term treatment depends on age, diagnostic confidence and control under current guidance. Anti-inflammatory treatment is central when indicated; repeated reliever use can signal poor control. Do not apply adult regimens automatically to younger children because age, device ability and licensing affect choices.
04Technique and adherence
Observe inhaler and spacer use directly, including the seal and inhalation sequence appropriate to the device. Ask non-judgementally about missed doses, cost and availability before stepping up treatment. Incorrect technique can mimic treatment failure and should be corrected with demonstration and rechecking.
05An action plan
Provide a written individual plan explaining daily treatment, worsening symptoms and emergency help. Review exacerbations, school participation and environmental exposures such as tobacco smoke. Arrange follow-up after an attack and reassess the diagnosis or specialist need if control remains poor despite optimised care.
High-Yield Revision
- A silent chest can indicate severe obstruction.
- Check technique before escalating chronic treatment.
- Age affects testing and treatment choices.
Common Pitfalls
- Calling every preschool wheeze asthma.
- Treating frequent reliever use as adequate long-term control.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.