Heroin addiction may increase the risk of pulmonary involvement. We describe the case of a 23 year-old woman who was admitted to our unit for severe asthma attack non responsive to beta-2-agonists and acute respiratory failure, soon after heroin inhalation. The patient was successfully treated with non invasive positive pressure ventilation. Opiate inhalation can be an asthma trigger and should be considered in the care of patients with poorly controlled asthma and life-threatening asthmatic attacks.