A child is having nocturnal asthmatic attack 2 times a day in a week, daytime attack in 3 times or more, can be categorised as?

Classification Of Childhood Asthma: Asthma Severity Days with symptoms Nights with symptoms Lung function Long term control Quick relief Medication Step 1 : Mild intermittent < 3 per week < 3/month FEV1 or PEF =80% of predicted; PEF variably <20% No daily medication needed Sho acting Beta- agonist as needed and before exercise; use =3 times /week may indicate need to initiate long term control therapy Step 2:Mild persistent = 3/week 3-4 /month FEV1 or PEF =80% of predicted; PEF variability 20 - 30% Anti-inflammatory: either low dose inhaled glucocoicoids, cromoglycate. nedocromil, or leukotriene modifier. Sustained-release theophylline is an alternative Sho acting Beta- agonist as needed and before exercise; daily use or increasing use may indicate need for additional long term control therapy Step 3: Moderate persistent Daily symptoms, daily use of sho acting beta- agonists >1 time/week FEV1 or PEF 60-80% of predicted; PEF variability >30% Anti inflammatory: inhaled coicosteroids (median dose) or inhaled glucocoicoids ( low dose) and either long acting beta agonist (LABA ), leukotriene modifier, sustained release theophylline, or LABA tablets Sho acting beta agonist as needed and before exercise; daily use or increasing use may indicate eed for additional long term control therapy. Step 4: severe persistent Continual symptoms, limited physical activity, frequent exacervations Frequent FEV1 or PEF =60% of predicted; PEF variability>30% Anti inflammatory: inhaled glucocoicoids (high dose) and either long acting beta- agonist (LABA ), leukotriene modifier, sustained release theophylline, or LABA tablets Oral glucocoicoids if needed. Sho acting beta agonists as needed and before exercise; daily use or increasing use may indicate need for additional long term control therapy Ref: Nelson's Pediatrics 17/e, Page 767.