Asthma is a common clinical condition characterized by wheezing, dyspnea, and cough resulting from reversible airflow obstruction. Histopathologic evidence over the past 30 years has emphasized the prominent role of airway inflammation, in conjunction with smooth muscle–mediated bronchoconstriction and intraluminal mucus as integral to the pathogenesis of this disorder.

The care of the patient with asthma is challenging, even to the most experienced clinician. The diagnosis of asthma is not straightforward and the clinical presentation is variable. Many patients with asthma can be managed satisfactorily through a combination of education about the disease process, potential inciting events, and ways to minimize them, as well as appropriate use of medications to prevent and control bronchospasm. For some patients, however, management can be difficult. Some patients do not receive adequate, early treatment, so that symptoms progress to life-threatening asthma. Others deteriorate in spite of aggressive treatment. As a result of the disease progression, patients develop status asthmaticus, life-threatening asthma characterized by progressive respiratory failure refractory to usual therapeutic interventions. Many of these patients require management in an intensive care unit, tracheal intubation, and mechanical ventilatory support. This article defines the pathophysiology of asthma and status asthmaticus in children and adults, describes clinical management options, and defines how to integrate an understanding of the disease process into a rational plan of management.