Efficacy and Safety of Combivent® Aerosol and Spacer, in Adult Patients With Moderate to Severe Asthma Crisis

Inclusion Criteria: * Male or female patients with a diagnosis of asthma according to the American Thoracic Society (ATS) presenting at the emergency room with an acute moderate and/or severe asthma attack * Patients aged between18 to 40 years * Patients able to perform spirometry (PEFR and FEV1) * PEFR \< 60% and \> 25 % of predicted normal value or a FEV1 \<= 60% of predicted normal value * Patients able to sign witnessed informed consent Exclusion Criteria: * Patients with very severe or life threatening obstruction, manifested by: * Cyanosis of tongue and lips * Confusion, drowsiness, coma or exhaustion * Silent chest on auscultation or weak respiratory effort * PEFR \< 25% the predicted normal value * Bradycardia (of less 60 beats/min) * Patients with a smoking history of more than 10 pack/years * Patients with chronic obstructive pulmonary disease (COPD) * Patients on treatment for or suspected as having glaucoma * Patients with uncontrolled hypertension * Patients with known allergy or contra-indications to either salbutamol, ipratropium or hydrocortisone or their excipients * Female patients known or suspected to be pregnant or nursing * Patients known or suspected on clinical grounds to have pneumonia, pneumothorax or pneumomediastinum * Patients with a history of chest surgery * Patients with other respiratory conditions if diagnosed. These included pulmonary fibrosis, bronchiectasis, cystic fibrosis, pulmonary tuberculosis, pulmonary complications of AIDS, lung cancer * Patients requiring drugs for the treatment of the acute asthma attack other than the study drug, hydrocortisone or oxygen * Patients who have previously recruited into this study * Patients who have been on other investigational drugs within three months prior to study entry * Patients with acute myocardial infarction, pulmonary edema or other life threatening disease, which in the judgment of the ER (Emergency room) physician precluded entry into the study * Patients with obvious or previous diagnosed serious hepatic or renal impairment or bladder neck obstruction