{ "schema_version": 1, "kind": "condition", "id": "preschool-viral-wheeze", "name": "Preschool viral wheeze (episodic viral wheeze)", "category": "chronic", "sources": "Pediatric Asthma - StatPearls (NCBI Bookshelf NBK551631) - https://www.ncbi.nlm.nih.gov/books/NBK551631/ · Egyptian National Drug Formulary - Respiratory System 2026 (salbutamol monograph) · Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-full.txt) · Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-clinical.txt)", "review_status": "reviewed", "verified_against": "Pediatric Asthma - StatPearls (NCBI Bookshelf NBK551631) - https://www.ncbi.nlm.nih.gov/books/NBK551631/ · Egyptian National Drug Formulary - Respiratory System 2026 (salbutamol monograph) · Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-full.txt) · Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1481, "generic": "Salbutamol", "line": 1, "is_adjunct": false, "form": "oral.inhalation", "strength_mg": 0.1, "adult_dose": "Not applicable - preschool viral wheeze is by definition a condition of children under 6 (see paediatric dosing)", "adult_duration": "As needed during an episode; reassess if needed more than twice a week", "dose_source": "Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-full.txt)", "rationale": "Indication and dose from the same disease-level article, which covers exactly this group: children whose symptoms come and go, set off as a rule by viral infection, and who tend to grow out of the episodes. Its first step is that every wheezing child should be able to use a short-acting beta-agonist, the sole exception being an infant of 1 year or under whose wheeze is from bronchiolitis. The dose is stated in the same document (see paediatric note). Named Salbutamol because that is the Egyptian register's spelling of the drug the article calls albuterol.", "cautions": [ "SPACER, ALWAYS - a child of 5 or under takes a pressurised metered-dose inhaler through a valved spacer, and at the younger end through a face mask as well. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) An MDI fired into a preschooler's mouth delivers almost nothing.", "WHEN TO STOP WAITING AT HOME - a child who responds well to the reliever, and whose symptoms have not come back within 4 hours, can stay at home, taking it every 4 to 6 hours if needed. One who does not respond fully takes a third rescue dose, and medical advice is sought.", "NOT FOR BRONCHIOLITIS - the article's stated exception is the infant of 1 year or under whose wheeze is bronchiolitis.", "ESCALATION TRIGGER - a child needing the reliever more than twice a week, over 1 month, moves up to step 2. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) Step 2 is a daily low-dose inhaled steroid; the article states no dose for it, so none is printed here - that is a referral or a paediatric-asthma decision, not a number invented for it.", "RISK MARKER - getting through more than 1 salbutamol inhaler a month is on the article's list of things that raise the risk of an attack. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) A family refilling monthly is not controlled.", "THE EGYPTIAN FORMULARY DISAGREES ON THE CEILING and the disagreement is real: its salbutamol monograph gives, for a child under 12 years, one inhalation of 100 mcg, or two inhalations, given up to 4 times a day, the daily dose must not exceed 800 mcg, and must not exceed 6 doses in 24 hours. The article's acute-rescue figures (4 to 8 puffs, up to 3 times in an hour) exceed that ceiling. The formulary's figure is a maintenance ceiling; the article's is an exacerbation regimen. Use the higher figures only for an acute episode, under review, not as regular dosing.", "The Egyptian formulary also notes that under 4 years another pharmaceutical form may suit better - i.e. nebuliser or MDI-plus-spacer-and-mask rather than a bare inhaler.", "Contra-indication (Egyptian formulary): hypersensitivity to salbutamol, or to any component of the preparation.", "Expect tremor and jitteriness: the formulary lists excitement (children, adolescents: 2% to 20%), nervousness (4% to 15%) and tremor (5% to 38%). The article notes that repeated doses lower the serum potassium, phosphate and magnesium, and raise the glucose." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Home or rescue use: 2 to 4 puffs from a salbutamol MDI, or a nebulised 1.25 to 2.5 mg for a child of 4 years or under and 2.5 to 5 mg for one aged 4 to 11. At the start of an exacerbation give the rescue dose and repeat it 20 minutes later. In the clinic: up to 3 doses of a larger amount over 1 hour - 4 to 8 puffs from the MDI, or by nebuliser 2.5 mg to 5 mg.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "AEROLIN 100MCG/DOSE INHALER", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO > 3M HEALTH CARE-U.K.", "price_egp": 7.3, "pack_count": null, "unit_price": null, "strength_mg": 0.1, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BUTALIN 100MCG/ACTUATION 200 DOSES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 12.0, "pack_count": null, "unit_price": null, "strength_mg": 0.1, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VENTAL INHALER 100 MCG/DOSE 200 DOSES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 72.0, "pack_count": null, "unit_price": null, "strength_mg": 0.1, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VIASALMOL 100MCG 200 ACTUATION INHALER", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MDI PHARMA", "price_egp": 72.0, "pack_count": null, "unit_price": null, "strength_mg": 0.1, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VENTOLIN EVOHALER 100MCG/ACTUATION INHALER", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 86.0, "pack_count": null, "unit_price": null, "strength_mg": 0.1, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OPICHESTAL SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL-OBOUR", "price_egp": 2.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "SALBUTAMOL 2MG/5ML SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 3.5, "pack_count": null, "unit_price": null, "strength_mg": 2.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "preschool-viral-wheeze" }, { "id": 1483, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-clinical.txt)", "rationale": "Carries the escalation and safety-netting the article states, which apply whichever reliever the family has.", "cautions": [ "RED FLAG - a child who does not respond fully takes a third rescue dose, and medical advice is sought. A child still working to breathe after three doses in an hour needs to be seen, not re-dosed at home.", "REFER - step 3 doubles the starting dose of the inhaled steroid for 3 months; where symptoms persist despite that, refer to an asthma specialist. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631)", "BEFORE ESCALATING, CHECK THE BASICS - where control is poor, first rule out a different diagnosis, check the medicine is actually being taken, watch the inhaler technique, and ask about tobacco smoke and allergens at home. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) In practice the commonest cause of failure is technique, not dose.", "SMOKE - keeping the child away from what sets the asthma off matters: tobacco smoke, first-hand or second-hand, triggers among foods and medicines, and pollutants and irritants generally. Ask who smokes at home; say it every visit.", "TEACH THE DEVICE - the patient and the carer must have the inhaler technique right, and must know which inhaler is the reliever, which the controller, and which does both. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) Watch the parent use the spacer before they leave.", "PROGNOSIS TO GIVE THE FAMILY - the episodic pattern tends to do better in adult life, and the article puts at 30% to 70% the proportion of asthmatic children who improve markedly, or lose their symptoms altogether, by early adulthood. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631)", "Write an action plan - one shaped to the individual child and to how well controlled the asthma is, so the family has a set way to handle a flare and to adjust treatment. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631)" ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "preschool-viral-wheeze" }, { "id": 1482, "generic": "Prednisolone", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "Not applicable - preschool viral wheeze is a condition of children under 6 (see paediatric dosing)", "adult_duration": "3 to 5 days", "dose_source": "Preschool viral wheeze (paediatric asthma) - disease-level clinical article (preschool-viral-wheeze-full.txt)", "rationale": "Indication and dose in the same article. It has a child of 6 to 11 with severe symptoms starting an oral corticosteroid soon after the reliever is begun, and gives the amount as 1 to 2 mg/kg/d of prednisone or prednisolone, capped by age: 20 mg/d from 0 to 2 years, 30 mg/d from 3 to 5, and 40 mg/d from 6 to 11. The course is 3 to 5 days. The article prints per-age ceilings for ages 0-2 and 3-5, which is why oral prednisolone is offered for preschoolers - but only as a clinician decision (see the first caution). Line 2: the reliever comes first.", "cautions": [ "CLINICIAN-INITIATED ONLY IN THIS AGE GROUP - the guidelines, the article says, do not back a carer giving oral steroids to a child of 5 or under. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631) Do not hand a preschooler's family a standby course to start at home.", "Give it AFTER starting the reliever, not instead of it - the oral steroid follows soon after the reliever has been begun. (Pediatric Asthma - StatPearls - NCBI Bookshelf, NBK551631)", "Short course only - 3 to 5 days. No taper is stated for a course this short.", "A preschooler needing oral steroids has had a significant episode; arrange review rather than repeating courses. Repeated courses are a reason to reassess the diagnosis and refer.", "Avoid in a child with active varicella or a systemic fungal infection, and check for recent chickenpox exposure before a course." ], "peds_mgkg_low": 1.0, "peds_mgkg_high": 2.0, "peds_max_mg": 20.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "1 to 2 mg/kg/day for 3 to 5 days. The article's ceilings are age-specific: maximum 20 mg/day in children aged 0 to 2, 30 mg/day aged 3 to 5, 40 mg/day aged 6 to 11. The calculator above applies the LOWEST stated ceiling (20 mg) so it can never over-dose the youngest child; for a 3-5 year old the article permits up to 30 mg/day.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 10, "high_mg": 20, "capped": false }, { "weight_kg": 20, "low_mg": 20, "high_mg": 20, "capped": true }, { "weight_kg": 30, "low_mg": 20, "high_mg": 20, "capped": true }, { "weight_kg": 40, "low_mg": 20, "high_mg": 20, "capped": true } ], "brands": [ { "trade_name": "HOSTACORTIN H 5MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 12.0, "pack_count": 30, "unit_price": 0.4, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PREDNISOLONE 5 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PREDILONE 5MG 10 TAB. (25 STRIPS PACK)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 250.0, "pack_count": 10, "unit_price": 25.0, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EPICOPRED 5 MG 30 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 69.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 79.5, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ANDALOUS PHARMA", "price_egp": 84.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI WINTHROP > SANOFI", "price_egp": 84.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ACETASEE 1% EYE DROPS (SUSP.) 5 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 7.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "PREDNIS 5MG/5ML SYRUP 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 9.5, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "preschool-viral-wheeze" } ] }