Summary: The Global Initiative for Asthma recently published a pocket guide that includes recommendations for the diagnosis and management of exacerbations and difficult-to-control asthma. Exacerbations of asthma are episodes characterized by intensive or progressive increase in symptoms and decrease in expiratory airflow from the patient’s usual status. Recurrent exacerbations can occur in any asthmatic, even in patients with mild well-controlled asthma. The most important thing is to identify patients at risk of asthma-related death. Assessment of exacerbation severity should be based on the degree of symptoms, oxygen saturation and lung function. In the therapy of asthma exacerbations one ought to consider effectiveness, safety and costs. Repeated dosing with inhaled bronchodilators (short-acting b2-agonists) and oxygen supplementation are the first line of management. Controlling medications (especially ICS) reduce the frequency and intensity of symptoms and the risk of exacerbations. Recently new biological drugs are recommended in recurrent exacerbations in severe asthma, but long-term studies will also be needed to determine whether these new treatments can prevent disease progression.