Patient information · Paediatrics
Asthma and wheeze in children
the spacer matters more than the inhaler
Wheeze is common in young children and does not always mean asthma. Whatever the label, the treatment of an attack is the same and the single biggest improvement most families can make is using a spacer properly — which delivers several times more medicine to the lungs than an inhaler alone.
Call 999 immediately if your child
- is too breathless to talk, eat or feed
- has lips or fingertips that look blue or grey
- is sucking in below the ribs or at the neck with each breath
- is unusually quiet, drowsy or floppy — a tiring child may stop wheezing, which is more worrying
- is no better after 10 puffs of the reliever inhaler
- has a reliever that wears off within an hour
Follow your child's written asthma action plan if it differs. Take the plan and inhalers with you to hospital. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
During an attack
1. Sit your child upright — do not lie them down — and stay calm; panic makes breathing harder. 2. Give one puff of the reliever inhaler through a spacer every 30 to 60 seconds, up to 10 puffs, taking 5 breaths from the spacer after each puff. 3. If they are worse at any point, or no better after 10 puffs, call 999. 4. If the ambulance takes longer than 15 minutes, repeat step 2.
Viral wheeze or asthma?
- Preschool viral wheeze — wheeze only with colds, well in between, typically under five. Many grow out of it by school age.
- Asthma — symptoms between colds too: cough at night, wheeze with exercise, laughing, cold air, pets or pollen, and a personal or family history of eczema, hay fever or allergy.
- Asthma is hard to diagnose confidently under five, so treatment is often trialled and reviewed rather than a label applied early. That uncertainty is honest rather than evasive.
The spacer — this is the important part
- Shake the inhaler and fit it into the spacer.
- Seal the mask over nose and mouth, or the mouthpiece between the teeth with lips closed.
- One puff at a time. Never fire several puffs into the spacer at once — the medicine sticks to the walls and is wasted.
- Five breaths after each puff, or 10 seconds of tidal breathing for a small child. Watch the valve move.
- Wait 30 seconds before the next puff.
- Wash the spacer monthly in warm soapy water and let it air dry — do not rinse or wipe, which builds static and reduces the dose.
The preventer is taken when they are well
The brown or orange preventer inhaler does nothing for an attack and everything for preventing one. It has to be taken every day, including through the summer and when your child seems completely fine — that is the medicine working, not evidence it is unnecessary. Stopping it in good spells is the commonest reason children end up in hospital. Rinse the mouth or brush teeth afterwards.
Warning signs between attacks
- needing the reliever three or more times a week
- night-time cough or waking with wheeze
- coughing or wheezing during PE or play
- missing school, or avoiding sport
- Any of these means the asthma is not controlled and needs reviewing before an attack, not after one.
Reducing triggers
Do
- Keep the preventer going daily, all year
- Have the flu vaccine each autumn
- Keep a spare reliever and spacer at school, in date
- Get inhaler technique checked at every review
- Ask for a written asthma action plan
Avoid
- Smoking or vaping anywhere in the home or car
- Damp and mould — report it if you rent
- Stopping the preventer over the summer
- Relying on the blue inhaler alone
- Waiting to see how a chest infection goes
Why come to us. Most children's asthma reviews are ten minutes and skip the thing that matters. We give unhurried paediatric appointments, seven days a week including weekends, watch your child use their inhaler and spacer and correct the technique, review the preventer, provide a written action plan for school, and test for the allergies that drive symptoms — allergy testing is performed here. Post-attack reviews are available within 48 hours.
Technique checked, action plan written, seen in 48 hours
Paediatric appointments seven days a week, allergy testing on site.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.