Which of the following statements regarding management of episodic viral wheeze is CORRECT? 

1.  Montelukast and inhaled corticosteroid cannot be used in combination in severe cases

2. There is no advantage to using a nebuliser over a spacer in management of episodic viral wheeze

3. Consider a long acting bronchodilator as first-line treatment

4. There is no need to consider environmental factors, especially parental smoking, before considering drug treatment

5. Oral steroids do offer significant benefit in terms of the length of hospitalisation, bronchodilator use or symptom scores

A 2014 review of the diagnosis and management of wheeze in preschool children suggested the following for treatment of episodic viral wheeze:

• Consider environmental factors especially parental smoking before considering drug treatment

• Consider if treatment is needed at all; intermittent bronchodilator therapy, either with a short acting beta agonist or short-acting muscarinic antagonist is first line treatment

• Ensure parents know how to use a spacer; there is no advantage to nebulising these drugs over the correct use of a spacer

• If there is inadequate symptomatic relief, consider intermittent treatment with montelukast started on the first day of an upper respiratory tract infection and discontinued when symptoms resolve, or intermittent inhaled cortisteroid; in severe cases a combination of inhaled cortisteroid and montelukast can be used

Resources:

RCGP. Wheeze & asthma in young children. EKU18. 2016 (reviewed 2022).

Bush A, Griggs J, Saglani S. Managing wheeze in preschool children. BMJ 2014; 348: g15.