High risk asthma signifies probable harm to the patient either because of periods of prolonged ventilatory defect, a clustering of manifestations indicating a poor prognosis, or severe life-threatening attacks. Ninety-five children referred to a university diagnostic center were classified as high risk and were selected from others with chronic asthma. These were observed at monthly intervals for at least two years. Ongoing disability usually resulted from failure to establish and eliminate causes and excessive dependence on adrenergic aerosols or corticosteroids. Case reports include patients with aspirin intolerance, allergic aspergillosis, α1-antitrypsin disease, misuse of adrenergic aerosols, and the effect of newer therapeutic agents in care of formerly unresponsive patients.