Increased morbidity and mortality due to asthma suggested the need to investigate whether persons with asthma report delay in seeking medical care during acute asthma exacerbations and the reasons they gave for delay. We interviewed 95 asthmatic adults, 36 men and 59 women, using a critical incident technique to discover how patients responded to acute asthma symptom episodes. Subjects were interviewed once per month for a total of three interviews. All subjects had physician-diagnosed asthma for a mean of 16.8+/-14.5 years. Eighty-six percent of the sample (n=82) reported delay in seeking medical care for severe asthma symptoms. Seven reasons for delay were identified: uncertainty, disruption, minimization, fear of systemic corticosteroid, previous bad experiences in emergency departments, the need to "tough it out" alone, and economic reasons. Seventy-one subjects (86.5%) reported three or more reasons for delay. Thirteen subjects (16%) identified pivotal episodes in which they realized they could die from asthma and as a result, no longer delayed. People with asthma often delay seeking urgent care for acute episodes for a variety of reasons. Some of these reasons are modifiable. Clear directions from health professionals to guide patients in responding to acute asthma episodes are needed. Asthma action plans written by the primary physician may be a positive agent of change for those who delay.