What is the approach to acute asthma exacerbation?

Immediate: oxygen to maintain SpO2 94-98%, inhaled SABA (albuterol/salbutamol) via nebulizer or MDI+spacer. Add ipratropium for moderate-severe. Systemic corticosteroids (oral preferred if tolerated) within first hour. IV magnesium sulfate for severe exacerbations not responding to initial therapy. Monitor peak flow, oxygen saturation. Consider ICU for impending respiratory failure. Discharge with oral steroids, reliever, and controller step-up. Follow-up within 1-2 weeks.