 Initial asthma severity will be based on PEFRs or clinical asthma scores table 1. If the child is able to reliably provide a peak flow in the emergency department this value will be recorded and calculated as a percentage of their predicted based on standardized height and weight charts. All peak flows will be performed by licensed respiratory therapists or trained registered nurses. If a childs effort during the performance of the peak flows is considered poor by the respiratory therapist then only the asthma score will be utilized. If a child can perform the peak flows adequately they will be sent home with the peak flow meter. All children will be assigned clinical asthma scores regardless of whether peak flows are obtained. With this asthma scale a score of less than 7 is considered mild, 8 to 11 moderate and a score of 12 to 15 severe. This asthma score has been shown to have good interobserver reliability with a Pearson correlation statistic of 0.92. 