This chapter aims to cover discussion on management of adult severe acute asthma. Severe acute asthma is an acute exacerbation of asthma that does not respond to standard treatments of inhaled bronchodilators and steroids. A score of 0.0–0.75 is classified as well-controlled asthma; 0.75–1.5 as a ‘grey zone’; and more than 1.5 as poorly controlled asthma. The asthma control test (ACT) includes four symptom/reliever questions plus a patient self-assessed level of control. The minimum clinically important difference is three points. Symptoms, differential diagnosis, assessment, and subsequent management of asthma are discussed briefly throughout this chapter.