Acute severe asthma is an extremely common and serious public health problem in the United States. Current optimum therapy of acute severe asthma includes supplemental oxygenation, nebulized beta-adrenergic receptor agonist therapy, and prompt use of glucocorticosteroids. In view of its low therapeutic index and the availability of more effective, less toxic agents, theophylline is no longer considered a first-line treatment. Ipratropium bromide combined with beta-agonist may augment bronchodilator responsiveness.