All patients with asthma are at risk of suffering an acute asthma attack over their lifetime, and these may finally be fatal. Hospitalizations and emergency department visits and intensive care account for a large proportion of the health-care cost burden of asthma. Thus, it is especially important to establish plans for prevention, education and therapeutic rationalization of primary care that establishes the disease and decreases its worsening. The severity of the exacerbations may vary from a mild to life threatening. The mortality is basically linked to inadequate assessment of the patient's severity. This leads to inadequate treatment in the emergency and delay in the patient's hospitalization. This review describes the epidemiology, costs, pathophysiology, mortality and management of adult acute asthma patients in the emergency department and intensive care, especially that related to non-invasive mechanical ventilation and conventional forms of mechanical respiratory care, with the current changes in its operational strategy.