The treatment of acute severe asthma in childhood should be focused on the control of bronchial obstruction and on the prevention of mechanical ventilation. These aims can only be achieved by a rapid and vigorous procedure using multiple therapeutic concepts. beta 2-Mimetics still play a major role. The inhalative route has priority; if necessary, even a continuous nebulization can be carried out. In some cases the intravenous route is of additional help. Corticosteroids should be administered parenterally and in high doses. Supplying oxygen has to be amongst the first therapeutic steps in ventilatory disorders with impending respiratory insufficiency. Mechanical ventilation should be undertaken in a gentle hypoventilating way under sedation and relaxation. Main attention has to be paid to preventive measures in order to ensure out-patient care with a maintenance therapy including antiinflammatory agents.