Asthma is a common in children and a small percentage required paediatric intensive care unit (PICU) admission. The severity of attack can be estimated by history, physical examination, lung function, oximetry, transcutaneous carbon dioxide and assessing response to initial therapy. Beta2 agonists, anticholinergics and corticosteroids are the initial treatments. In this article, the common initial treatment will be updated followed by discussion on additional treatment after admission to PICU. (J Pediatr Resp Dis 2011; 7:77-85)