The American Academy of Pediatrics, and its Provisional Committee on Quality Improvement in collaboration with experts from the Sections on Allergy and Pulmonology, general pediatricians, and research methodologists have developed this practice parameter. This parameter is based on the work reported by the National Asthma Education Project of the National Heart, Lung, and Blood Institute. It differs by specifically addressing the treatment of acute exacerbations of asthma in the office setting as opposed to the emergency department or hospital, and by providing a rigorous analysis of the scientific evidence supporting some of the key recommendations in the report. The recommendations derive from both expert consensus and a review of the medical literature. A detailed discussion of the Committee selection and the methods used can be found in the technical report that is available from the Division of Quality of Care, American Academy of Pediatrics. This practice parameter is not intended to stand alone in the treatment of the child with asthma. It is designed to assist pediatricians by providing an analytic framework for the evaluation and treatment of acute exacerbations of asthma. It is not intended to either replace clinical judgment or to establish a protocol for all patients with asthma. It rarely will be the only appropriate approach to the problem.