Asthma is a common disease that afflicts as many as 5% of Americans. S
evere exacerbations of asthma can be life-threatening if not treated a
ggressively. Despite publication of therapeutic guidelines developed b
y experts in this field, the clinical management of severe exacerbatio
ns of asthma varies widely among institutions and practitioners. This
article briefly reviews the pathophysiology of asthma and outlines a s
ystematic, mechanistic approach to treating patients with severe asthm
a that integrates many clinical advancements made during the past 5 to
10 years.