Assessment and management of children aged 1 - 59 months presenting with wheeze and fast breathing: multicenter study in Pakistan and Thailand

INTERVENTION: 1. Inhaled Salbutamol and reassessment after up to three cycles of bronchodilator therapy repeated at 15 minute interval if necessary 2. Metered Dose Inhaler (MDI) with spacer device CONDITION: Wheeze and fast breathing ; Respiratory ; Respiratory problems PRIMARY OUTCOME: Proportions of children aged 1 ‐ 59 months with auscultatory wheeze and fast breathing or lower chest indrawing:; 1. Respond to up to three cycles of inhaled salbutamol: response defined as no fast breathing or lower chest indrawing present; 2. Fail therapy at day 3 or days 5 ‐ 7 of the initial successful bronchodilator therapy with inhaled salbutamol? Therapy failure defined as:; 2.1. Relapse: develop fast breathing or chest indrawing afresh, that does not respond to three cycles of inhaled salbutamol; 2.2. Development of any danger sign (except wheezing and fever in young infant); 2.3. Death ; 2.4. Severe adverse reaction to salbutamol SECONDARY OUTCOME: In children aged 1 ‐ 59 months with auscultatory wheeze and fast breathing or lower chest indrawing:; 1. Proportion with audible wheeze at initial assessment; 2. Proportion of responders to up to three cycles of inhaled salbutamol associated with:; 2.1. Age ; 2.2. Respiratory Syncytial Virus (RSV) isolation; 2.3. Season; 2.4. Number of previous wheezing episodes; 2.5. Audible versus auscultatory wheeze; 2.6. Family history of asthma; 3. Proportion of relapses in children who showed initial improvement associated with:; 3.1. Age ; 3.2. RSV isolation; 3.3. Season; 3.4. Number of previous wheezing episodes; 3.5. Audible versus auscultatory wheeze; 3.6. Family history of asthma; 4. Received any antibiotic for this or any concurrent illness before follow‐up; 5. Loss to follow‐up; 6. Withdrawal of consent INCLUSION CRITERIA: 1. Age 1 to 59 months 2. Audible/auscultatory wheeze 3. Respiratory rate above age specific cut off point or lower chest indrawing 4. Classified as no pneumonia with wheeze