211 Asthma is a common disease characterized by clinical airflow obstruction that can usually be reversed after a simple bronchodilator treatment. Many physicians, and even some patients, tend to view acute exacerbation of this disease as an annoyance that will pass, rather than a potentially lifethreatening event. Nevertheless, several reports indicate that asthma mortality has increased during the last few decades, although the absolute number of deaths is still relatively small [1] [2] [3]

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... ] . To prevent death from asthma, it is important to identify patients who are at risk of a fatal attack. The purpose of this study was to evaluate the clinical features of fatal asthma and to identify the possible warning signs associated with a fatal asthma attack. To characterize the clinical features of fatal asthma, we retrospectively analyzed the clinical characteristics of patients who died of an acute asthma attack in our hospital during a 15-year period from 1989 to 2003. Twelve patients had fatal asthma during this period, including eight who were dead on arrival in the emergency room (ER) and three who died within 1 hour of admission to the ER. Patients were categorized into three groups according to the clinical presentations during the fatal attack: (1) rapid (< 3 hours) decompensation in four patients; (2) gradual development of respiratory failure over several days in two patients; and (3) acute deterioration after unstable asthma lasting several days in six patients. All patients in groups 1 and 2 had reported previous near-fatal attacks. The proportion of young patients was highest in group 3, with half of them (3/6) younger than 35 years of age. Only one patient in group 3 had had a previous near-fatal attack. Five of the seven patients, with previous near-fatal attacks, had a pattern of decompensation during their fatal attack that was similar to their previous attacks. In conclusion, nearly all patients with fatal asthma in this study died outside of the hospital or within 1 hour after admission to the ER. Patients had patterns of decompensation during the fatal attack that were similar to those of their previous attacks. Early detection of warning signs, early admission to the ER, adequate treatment, and extremely close observation of patients, especially within 1 hour after ER arrival, may prevent or decrease the incidence of fatal asthmatic attack. This retrospective study included adult patients (age >15 years) who died of an acute asthma attack during a 15-year period from January 1989 to December 2003 at National Cheng Kung University Medical Center, a tertiary-care medical center in southern Taiwan. Data collected from medical records included asthma history, date of attack, and clinical characteristics such as age, gender, duration between onset of symptoms and fatal attack, patterns of decompensation, and history of previous admissions due to near-fatal attacks. Data on parameters associated with the fatal attack, including blood pressure, heart rate, respiratory rate, arterial blood gas analysis, and potassium level were also collected. We defined patients as having asthma if they had had a previous diagnosis of asthma by a physician and presented with at least one of the following two conditions: (1) subjective evidence of variable wheezing and/or