To the Editor.—In a recent article Wood et al1 proposed an objective scoring system for degrees of respiratory distress in patients with asthma; this system was subsequently used2 to evaluate clinical status in a therapeutic trial of intravenous isoproterenol. I wish to point out that there is an inconsistency within the scoring system.
The Table is a reproduction of the Wood scoring system. It is inconsistent that "marked" expiratory wheezing can be present when air movement is "decreased to absent." Clinical experience3 shows that respiratory failure (cyanosis, PO2 less than 70 mm in 40% oxygen, maximal use of accessory muscles, and coma) is not accompanied by marked wheezing; the child at greatest risk is so tired and so depressed from CO2 retention that he can no longer make the tremendous effort necessary to move air, with the result that wheezing actually decreases.
I suggest that