The dose and type of maintenance asthma medications required to control symptoms between acute exacerbations, is useful information about the frequency and severity of the patient's interval symptoms. The crepitations heard in asthma are usually due to mucus plugging and not a bacterial infection. Assessment of Severity Mild - a child with mild asthma will have an audible wheeze but little respiratory distress. There will be no palpable paradox and breath sounds over the two hemithoraces will be normal. Moderate - some respiratory distress with wheezing but no cyanosis in air, pulsus paradoxus probably not palpable, but may be up to 15 mmHg by auscultation.
Normal breath sounds bilaterally.
Severe - respiratory distress with the use of accessory muscles. In some mild cases, only one dose of oral steroids is necessary whilst in others a 3-5 day course may be required. This duration of treatment with steroids will be guided by the expected response to treatment. For patients receiving maintenance oral or inhaled corticosteroids the dose of steroids must be tapered to the maintenance dose once the acute exacerbation has resolved. Theophylline is not commonly prescribed as a maintenance asthma medication.