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Asthma is a common disease process and is also a common presentation to the Urgent Care setting. Most asthma exacerbations are easily controlled with inhaled Albuterol. But when a patient is having a severe asthma exacerbation the clock is ticking! Initiating therapy and immediate transfer to the Emergency Department is critical. Therapies that should be given if available include: Oxygen, Albuterol, Ipratropium, Epinephrine, Magnesium, and Steroids. Non-invasive ventilation, Terbutaline, and Ketamine should be considered as well when available.