Dr Phil Kieran: My daughter has started to wheeze - does she need an inhaler?

When your child has had asthma but appears to have grown out of it, it can be heartbreaking to hear that telltale wheeze again. Instantly you are worrying if you are back to square one. Will this mean they won’t grow out of it at all? Will they be stuck with inhalers for their whole life?

Thankfully, this is rarely the case.

Asthma is a condition where the muscles in the airways squeeze close excessively, and the airways produce more mucus than they should. It is treated with two types of inhalers (sometimes tablets such as montelukast too but we’ll stick to the inhalers for now).

One is a rescue inhaler (blue\salbutamol) and the other is a preventer inhaler (often brown but can vary). The blue inhaler instantly opens the airways, giving instant results, so people often remember to use it. The preventer inhaler is more likely to be forgotten but is, on the whole, the far more important of the two.

When the airways are hyper-reactive, as they are in asthma, it tends to be a self-perpetuating issue. If you use more and more of the blue inhaler, you end up needing more and more of it. If you go through more than four blue inhalers per year (not counting the ones you use before exercise), you need an increase in your preventative treatment. This advice applies to adults and children. 

In the case of your daughter who has been off asthma treatment but is wheezing again, the most likely cause is a mild viral infection. Viral infections are responsible for about 15% of all wheezing in children and it has likely re-triggered her asthma. If asthma is well controlled, you may not need inhalers much, but the tendency is still in the background. Most people will grow out of their asthma at puberty but it is uncommon to go permanently before that. 

If she is coughing and wheezing again, I would say she needs to go back on her preventer inhalers. If you restart inhalers it is vital to stick with the preventative treatment for at least three months to help the airways settle down. It is worth making a GP appointment as, depending on the child, your doctor may recommend a combination inhaler that can be used as a regular preventer or a rescue inhaler when you feel it is needed. This is called MART (Maintenance And Reliever Therapy) and a lot of people find it easier to use.

Overall, the wheezing does not signal a return to severe asthma but is a reminder that some people will need to go on and off inhalers for a few years before it fully settles. Your GP is probably the best-placed person to advise on this but remember the preventer is more important than the reliever.

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