Purpose of the study: To search for scientific evidence of the benefit for external chest compression in acute asthma. To report a case in which external chest compression was used in the management of acute severe asthma in the prehospital setting. Materials and methods: A literature survey was made. One pilot study, four case reports and three reviews were found. A case from the Göteborg EMS is reported. Results: Literature survey: Most patients with asthma and acute exacerbation respond to conventional therapy. A small percentage deteriorate and develop a condition that may even be fatal. The effect of external chest compression in patients with severe and life-threatening asthma, is discussed. This intervention seems to be most beneficial in patients suffering from sudden onset asphyxic asthma. No adverse effects have been found. Case report: A 25 y/o male with asthma was found unconscious and with respiratory arrest at ambulance arrival. Percutaneous oxygen saturation was down to 50%. Mechanical ventilation was not possible due to high airway resistance; therefore external chest compression was applied. Parallel with mask-to-mouth ventilation, external chest compression was performed during approx. 40 min. No drugs were administrated during this period, except for oxygen (6 l). The patient was discharged from hospital fully recovered after 2 days. Conclusion: External chest compression may be a treatment strategy in patients with air trapping due to acute asthma, and may serve as a complement to pharmacological treatment. This intervention is analogoues to CPR in cardiac arrest, and has possibly the greatest impact in the prehospital setting.