Abstract Patients with the discharge diagnosis of bronchial asthma at the Children's Hospital of Pittsburgh (CHP) were reviewed from 1935 to 1968. In the last 10 years, the number of patients hospitalized with acute severe asthma has doubled, and asthma patients account for more than 5 per cent of the medical hospitalizations. Concomitantly, there has been a decline in the mortality rate. Nine deaths occurred in the 33 year period, and 2 deaths were in the last decade. Seven of the patients who died were female, although the ratio of male to female hospitalized asthmatic patients was almost 2 to 1. Medical therapy was reviewed, and overmedication with aminophylline and sedatives were important in 6 deaths. Eight autopsies were performed, and infection was noted at postmortem examination in 5 patients. In contrast to several recent reports, the number of asthma deaths at CHP has not increased with the increased hospitalizations for asthma in the last 5 years. The vigorous correction of acidosis and dehydration, the availability of assisted ventilation, and possibly the use of steroids may account for this observation.