Asthma is one of the most common chronic diseases of childhood. The incidence of hospitalizations for acute exacerbations are increasing. Status asthmaticus is a medical emergency that can result in respiratory failure and death if not treated properly. An understanding of the pathophysiology of asthma and an acute exacerbation lay the foundation for competent nursing care. An accurate assessment includes a rapid and thorough history, evaluating the level of consciousness, respiratory effort, vital signs, oxygen saturation, arteria blood gases, and peak expiratory flow rates. Management issues include standard pharmacologic interventions and other therapies, hospital admission, controversial pharmacologic management, assisted ventilation, psychosocial care, and education.