The occurrence of an acute exacerbation of asthma frequently reflects failure of a first line treatment that has to be reconsidered. Severe episodes of acute asthma are often related to non-recognition of signs of gravity, inadequate treatment and/or delayed access to an emergency department. Several consensus conferences have established guidelines for management of asthma attacks in the patient's home, and have defined the symptoms which should lead the physician to refer the patient to an emergency department and the criteria of hospitalization when the patient does not respond properly to the treatment. Guidelines for management of acute asthma based on the currently recommended therapeutic schedules are presented.