asthma is a disease with high prevalence in our country and around the world. although new therapeutic approaches have been recently developed, there appears to be a worldwide increase in morbidity and mortality from asthma. in many institutions, asthma exacerbation is still a common medical emergency. clinical evidence demonstrates that the first hour of management of acute asthma in the emergency room entails crucial decisions that could be determinant in the clinical outcome. in this non-systematic review, the authors focus on the first hour assessment and treatment of patients with acute asthma and outline an appropriate strategy for their management. diagnosis, severity assessment, pharmacological treatment, complications, and the decision regarding the place where additional treatment will take place will be considered. it is reasonable to expect that these recommendations will help physicians make appropriate decisions about the first hour care of acute asthma in the emergency room.