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Progression of an acute asthma attack to a severe asthma exacerbation can occur rapidly and lead to devastating consequences, such as hospitalization and respiratory failure. Physiologic processes leading to severe asthma exacerbation may include inflammation, inappropriate hyperresponsiveness of bronchial cells, and excessive mucus production. Specific treatments for acute severe asthma consist of oxygen, intermittent or continuous bronchodilators, systemic corticosteroids, and magnesium sulfate. Close monitoring of patient progress is critical to identify patients most likely to have a severe course of illness. Prior to discharge, patient education and identification of obstacles impeding successful management and control of asthma must be addressed.