Overview of wheeze and asthma in children 1 to 5 years

Recurrent wheeze is common in children aged 1 to 5 years, and is most often a symptom of a viral respiratory tract infection, which can occur 6 to 8 times per year in this age group. Most of these children do not have asthma.

Assess children aged 1 to 5 years with wheeze to determine whether treatment is required, and to investigate alternative diagnoses.

Asthma cannot be formally diagnosed or excluded in young children, as they are unable to perform spirometry and too young for a clear pattern of symptoms to be established. A trial of a short-acting beta₂ agonist (SABA) is not diagnostic—many young children whose symptoms respond to SABA therapy do not have asthma in later childhood. Even a ‘provisional’ diagnosis of asthma in this age group requires continuous reassessment, and a long-term diagnosis must not be made until the child is old enough to perform spirometry, or the pattern of symptoms is clear. See Clinical assessment of wheeze in children 1 to 5 years for more information.

Treatment of wheeze in children 1 to 5 years is often not necessary. It is usually initiated when symptoms are bothersome (eg limit daytime activities, affect sleep). For recurrent bothersome symptoms, short-term treatment with an as-required SABA reliever (eg salbutamol) is usually sufficient. A small number of children with frequent or severe viral-induced symptoms (eg requiring emergency-department visits), or with symptoms between infections, may benefit from a regular preventer. Drug therapy in this age group should always be considered a treatment trial, with continuous reassessment to determine the need for ongoing treatment. See Treatment trial for wheeze and asthma in children 1 to 5 years for more information.