Does wheezing have to be present in the patient assessment to administer Ventolin?

Great question. You are correct that bronchoconstriction can be manifested in symptoms apart from wheezing, for which Ventolin (salbutamol) may be indicated. The OBHG Companion Document states that “Symptoms of bronchoconstriction may include wheezing, coughing, dyspnea, decreased air entry and silent chest.” and stipulates that, “suspected bronchoconstriction applies to asthma, COPD, and other causes of bronchoconstriction”. The Indication for Bronchoconstriction Medical Directive is, “Respiratory distress; AND Suspected bronchoconstriction”.  Therefore, if you have a patient experiencing respiratory distress and is manifesting other symptoms of bronchoconstriction (with a condition such as asthma, COPD or other cause of bronchoconstriction), it would be reasonable to administer salbutamol.