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Asthma, Viral Wheeze, Bronchiolitis and Croup – what are they and how are they different?

I thought I’d do a quick (hopefully 😊) and timely post about asthma, bronchiolitis and croup this morning as I know we are heading into the time of year when there is so much of it around.

This post was inspired by a few children that I’ve recently treated with respiratory illnesses, including my own 6-year-old daughter. It can get confusing trying to understand the differences in these respiratory illnesses as they are similar in some ways, but different in others – and ALL of them are common.


Asthma by definition is a chronic condition of the lungs that causes a recurring or persisting cough, difficulty breathing and wheezing.  The wheezing sound is caused by constriction of your airways, mostly the small tubes that carry air down into your lungs.  If children have had only one or two episodes, then we tend to call a “viral wheeze or reactive airways disease”.

The narrowing of the airway is usually caused by some type of trigger (e.g., cold air, exercise, pollens, a virus or bacteria) that cause your airways to react and constrict. The airway narrowing is reversable by using an inhaled medication called salbutamol (also known as “Ventolin” or “Asmol”).

A few points about asthma:

  • It is important that your child has an asthma management plan to help both you and their childcare educators or teachers care for them.
  • Poor control of asthma can cause fatigue, poor sleep and long term reduced lung function.
  • Annual flu vaccines help reduce the risk of asthma attacks.

Bronchiolitis is a respiratory illness in children that causes inflammation of the lower airways.  The infection is usually some sort of virus (e.g., Respiratory Syncytial Virus (RSV) or Influenza).  It usually causes a flu-like illness that affects infants in the first year of life.

The symptoms start with a runny nose and cough on the first 1-2 days. It can then progress to a worsening cough, wheeze and fever. Babies are often sickest on the 2nd and 3rd days and will usually start looking better on the 4th or 5th day.  They are often unwell for about 7-10 days in total. Some babies can develop breathing difficulties that can lead to fatigue, and trouble with feeding This can then lead to dehydration, noted by observing less than three wet nappies in a 24hr period.  Sometimes these children need to be admitted to hospital for breathing support, or rehydration. The cough can persist for up to 4 weeks or more after the infection.

We do not usually order blood tests or chest X-rays for bronchiolitis as it is a clinical diagnosis.

A few points about bronchiolitis:

  • Antibiotics do not work to kill viruses, so they are not given to treat bronchiolitis.
  • Salbutamol (i.e., Ventolin) is not helpful in treating bronchiolitis, as the airway wheezing is not reversible as in asthma.
  • Steroids do not help to change the course of disease.

You should seek medical attention if your child looks like they are having trouble breathing, are not feeding well, or appear exhausted.


Croup is a respiratory condition that causes swelling of the upper airways. It is caused by a viral infection and typically it affects children up until the age of 5. Having said that, I have seen children where symptoms occur up to the age of 8. Some children might only get croup once, whereas other children can have it repeatedly.  It can sometimes be mild but can also get worse very quickly.  If you think your child is having trouble breathing, you should seek medical attention immediately.

The illness often starts like a cold, but then the cough will change in sound and become harsh, like a dog or a seal barking.  Your child’s voice might also sound hoarse. If the upper airway narrowing is severe enough, your child might have a high-pitched noise on breathing in, which can become worse if they are distressed.  Croup can last for 1-4 days and the symptoms often worsen at night. Typically, the most severe occurrences are on the 2nd or 3rd nights.

A few points about croup:

  • Sometimes steroids are given orally for croup.
  • Antibiotics do not work on viruses, so they are not given for the management of croup.
  • Keeping your child as calm as possible helps e.g., read a book, or watch a video.
  • If they are miserable/irritable with a fever, children’s paracetamol or ibuprofen can help.

I hope this helps some other parents out there navigate through the autumn and winter months.

Our doctors are used to seeing lots of babies/children with respiratory illnesses. Please get in touch if your child is experiencing respiratory symptoms and you are worried about them