The number of patients presenting to the emergency department with severe acute asthma exacerbations is increasing. Prompt and aggressive therapy often ameliorates the symptoms and decreases the morbidity and mortality associated with this disease. A directed history and physical examination should be performed, often simultaneously with treatment. The use of inhaled beta-adrenergic agents and the early use of corticosteroids will reverse most attacks. In addition, the use of anticholinergic agents may benefit selected patients. Despite aggressive treatment, some patients will require endotracheal intubation. Controlled intubation with proper sedation and paralysis will decrease the associated morbidity. Complications associated with mechanical ventilation may be prevented by decreasing the amount of auto-PEEP by controlled hypoventilation. Asthma, when incompletely or inadequately treated, can be a rapidly fatal disease process. Conservative approaches to patient admission based on strict objective pulmonary function testing should decrease morbidity and mortality.
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