Treatment trial for wheeze and asthma in children 1 to 5 years

Many children aged 1 to 5 years don’t require acute treatment for their wheezing episodes as they do not limit activity or affect sleep.

For recurrent bothersome wheeze associated with increased work of breathing, asthma treatment can be trialled to reduce the frequency and severity of symptoms. Drug therapy in children aged 1 to 5 years should always be considered a treatment trial, with continuous reassessment to determine the need for ongoing treatment.

Short-term treatment with an as-required reliever (salbutamol via pressurised metered dose inhaler [pMDI]) is usually sufficient. Use:

If the child’s symptoms do not show a clear response to correctly used bronchodilator therapy, consider possible alternative diagnoses (see Alternative diagnoses that can be confused with asthma) as this could indicate that the provisional diagnosis of asthma is incorrect.

Counsel parents and carers to give salbutamol when the child has wheeze associated with increased work of breathing; it is not necessary for isolated cough or for mild wheeze without increased work of breathing.

Educate parents and carers about how to use the inhaler, including advice about using a spacer (recommended for all children) and a mask (useful for young children). See here for information about using masks and spacers, and Summary of inhalational drug delivery devices for links to instructional videos and patient handouts for pMDIs.

A small number of children with frequent, severe symptoms that occur with viral respiratory tract infections, or with symptoms between infections, may benefit from a preventer. For detailed information about trialling preventer therapy in children aged 1 to 5 years, see Maintenance management of asthma in children.