R E V I E W EUR ANN ALLERGY CLIN IMMUNOL Summary Near-fatal asthma (NFA) is described as acute asthma associated with a respiratory arrest or arterial carbon dioxide tension greater than 50 mmHg, with or without altered consciousness, requiring mechanical ventilation. Risk factors for near fatal asthma have not been fully eluci- dated. In 80-85% of all fatal events, a phenotype, characterized by eosinophilic inflammation associated with gradual deterioration occurring in patients with severe and poorly controlled asthma, has been identified. Regarding to the management, acute severe asthma remains a significant clinical problem, which needs to be identified to facilitate early and appropriate therapeutic interventions. The assessment relies on clinical signs, but additional information might be obtained from chest radiography or blood gas analysis. No investigation should delay the initiation of appropriate therapy. The goals of therapy are the maintenance of oxygenation, relief of airflow obstruction, reduction of airways edema and mucus plugging (with Increased use of medications such as beta-agonists via metered dose inhalers and nebulizers, oral and/or intravenous (other than by inhalation) corticosteroids and oral or intravenous theophylline) whereas supporting ventilation as clinically indicated. Of course, the emergency physician needs to consider the wide range of potential complications, as attention to these problems when managing severe acute asthma might significantly improve outcome. An understanding of the available agents and potential pitfalls in the management of NFA is mandatory for the emergency physician. Corresponding author Gennaro D’Amato University Professor of Respiratory Medicine Division of Respiratory and Allergic Diseases Department of Chest Diseases High Speciality A. Cardarelli Hospital, Naples, Italy Centro Studi Salute e Ambiente, Via Rione Sirignano, 10 80121 Naples, Italy E-mail: gdamatomail@gmail.com KEY WORDS near fatal asthma; acute asthma; severe asthma; asthma attack; asthma exacerbations; asthma-related deaths 1 Division of Respiratory and Allergic Diseases, Department of Chest Diseases High Speciality, A. Cardarelli Hospital, Napoli, Italy 2 University “Federico II”, Medical School of Respiratory Diseases, Naples, Italy 3 Department of medicine and surgery, University of Salerno, Italy 4 First Division of Pneumology, High Speciality Hospital “V. Monaldi” and University “Federico II” Medical School, Naples, Italy 5 Second Division of Pneumology, High Speciality Hospital “V. Monaldi” and University “Federico II” Medical School, Naples, Italy 6 Autonomic Service of Pneumology, Policlinical University Federico II, Naples, Italy 7 Service of Immunoallergology, University Hospital “Ospedali Riuniti”, Ancona, Italy 8 Service of Allergology, Hospital san Paolo, Civitavecchia, Italy 9 Division of Pneumology, Hospital Mater Salutis, Legnago,Verona, Italy 10 Division of Pneumology, Hospital Salvini, Garbagnate, Milan, Italy Near fatal asthma: treatment and prevention G. D’AMATO 1,2 , C. VITALE 3 , M. LANZA 4 , A. SANDUZZI 5 , A. MOLINO 4 , M. MORMILE 6 , A. VATRELLA 3 , MB. BILÒ 7 , L. ANTONICELLI 7 , M. BRESCIANI 8 , C. MICHELETTO 9 , A. VAGHI 10 , M. D’AMATO 4 VOL 48, N 4, 116-122, 2016 Background Asthma is a significant public health problem that is increas- ing in prevalence and is associated with relevant morbidity and financial costs (1,2). There is suggestion that asthma-related deaths are decreasing, but a significant minority of individu- als presents with severe asthma and have persisting daily symp- toms, and exacerbations despite compliance with high doses of inhaled steroids and additional treatment. For this small part of the asthmatic population, the exacerbation can become fatal or near-fatal (1-10). These observations appear to be paradoxi-