[Acute severe asthma].

Many problems remain to the solved in the management of acute bronchial asthma. Acute fatal or near-fatal asthma can occur in apparently low-risk patients. Patients should be educated about the potential risk of the disease. Subjective degree of dyspnea perceived by the patients was useful in judging the severity of the attack and in predicting the outcome, i.e. need for hospitalization after the initial treatment. However, clinical status on arrival at the emergency room did not predict the out-come. In the treatment of acute attacks, the optimal dosage and timing of corticosteroids and the effectiveness of aminophylline remain controversial. Many patients with respiratory failure due to acute severe asthma can be successfully treated without mechanical ventilation. There have been very few clinical studies of acute asthma in Japan. Appropriately planned and performed clinical studies are clearly necessary to solve the problems encountered in the management of acute asthma, and such studies should be done in Japan.