The objective of this study was to retrospectively review the medical records of 38 consecutive admissions to the medical intensive care unit of a tertiary-care university hospital of patients with severe asthma, and to determine the clinical characteristics of these patients, treatment regimens, and ultimate outcome. The 38 patients presented with severe asthma accompanied by hypoxemia, hypercapnia (mean pCO2 of 54.3 +/- 4.5 mm Hg), and decreased peak flow rates (125.5 +/- 12.4 L/min). The patients spent a mean of 60.1 +/- 9.7 hr in the medical intensive care unit. Seventeen of the 38 patients required intubation and mechanical ventilation. Overall, there were no deaths or significant complications. All 38 patients were discharged from the hospital. We conclude that severe, life-threatening asthma can be appropriately managed in the medical intensive care unit with a low incidence of complications and death. Prolonged mechanical ventilation is rarely required and most patients respond while the relatively simple management strategies.