Grading of asthma-Pediatric Oncall

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Question
Sir, My doubt is about the grading of asthma. Asthma is a disease, where the symptoms such as cough and wheezing are more at night compared to the day time. But when we are looking at the grading, it will appear as if the night symptoms are comparatively less frequent than the day symptoms. For example, in moderate persistent asthma, criteria for symptoms - are daily symptoms and for nocturnal symptoms it is more than ? once a week. If a person is having daily asthmatic symptoms ,won?t he be having daily nocturnal symptoms as well ?. To meet the criteria of mild persistent asthma, you need to have symptoms ? more than once a week, but need to have the nocturnal symptoms ? more than twice a month only. According to the standard teaching, if some is having asthmatic symptoms more than once a week,he will definitely have night symptoms at the same or increased frequency. I hope that I have made my point clear. Please give your valuable opinion. Dr Manoj Chandran. Specialist Pediatrician Musalla Medical center. Dubai,UAE.
Answer
Grading is suggested on the basis of symptoms (night time/ day symptoms), PEFR and FEV1. Depending on the grading of each parameter, you can grade the child into the various types. In mild intermittent, daytime symptoms have to be more frequent (Symptoms twice a week or less ) whereas even if there are more than Nighttime symptoms twice a month then it will be mild persistent asthma. Thus, if night time symptoms are even more, the severity of asthma will be greater. Back to All Questions

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