Current management of acute asthma has been defined in clinical practice guidelines developed from systematic reviews and expert opinion. Initial treatment with inhaled high-dose beta-agonists and anticholinergics is recommended for severe exacerbations. Most patients treated in emergency departments should receive systemic corticosteroids. Adjunctive therapy for those not improving is less well-defined, but options include intravenous magnesium sulfate and heliox-driven nebulized beta-agonists. Poor adherence to preventive therapies and infrequent primary care follow-up are well documented among children and adolescents treated in emergency departments. These factors may contribute to disparities in outcomes for minority populations and are important considerations during acute care visits.