Acute attacks of wheeze or asthma remain among the most common reasons for paediatric hospital attendance and rates of severe attacks in the UK are among the highest in Europe. Although most attacks are precipitated by infection, there are critical differences in the underlying pathophysiology between preschool and school-aged children. Allergen sensitisation, airway eosinophilia and type 2 inflammation are predominant in older children, while phenotypes in younger children are variable, often including non-atopic, neutrophilic infection driven episodes. Currently, a universal approach is adopted towards management in all ages, but there is a need to make objective assessments of airway function, inflammation and infection both during the attack and in disease stability to identify “treatable traits” and target therapy if we are to improve outcomes. An assessment of risk factors that led to the attack and early, focussed follow-up is essential to ensure attacks are a “never event”.