Asthma prevalence and mortality have been increasing over the past 2 decades, despite advances in medical therapy. In 2003 the National Health Interview Survey reported over 4,000 asthma-related deaths. A small proportion of people with severe asthma use a large proportion of health-care resources and bear the burden of asthma-related morbidity and mortality. The management of acute asthma is complex and evolving. Understanding the phenotypes and pathophysiology of acute asthma will lead to increased recognition and characterization of populations at risk for fatal asthma. The early identification and appropriate management of acute asthma is critical in decreasing asthma morbidity and mortality. This paper reviews current pharmacologic and nonpharmacologic management of severe acute asthma.