Despite widespread use of theophylline in the hospital management of asthma, supportive data justifying its use are sparse. Clinical research in the 1980s has forced a serious new examination of the drug's role in acute exacerbations of asthma. Because of the morbidity, mortality, questionable value, and overall cost of theophylline therapy, this reevaluation is of particular importance. Enhanced knowledge of the value of treatment with intensive inhaled beta agonists, systemic glucocorticoids, and inhaled ipratropium should prompt elimination of the routine, initial use of theophylline in emergency room care of most asthmatics. Further research is necessary to justify the routine, initial use of the drug in hospitalized asthmatics.