[Fatal asthma].

Fatal asthma is rare but constitutes a serious public health problem on account of the raised prevalence of the disease. The incidence of fatal asthma is estimated at 3/100,000 people in France and the incidence of fatal asthma has not ceased to rise in the world despite therapeutic progress. The principal risk factors recognised are: 1. longstanding asthma, 2. unstable asthma, 3. acute severe asthma with a prior history, 4. insufficiently treated asthma or poorly compliant patient, 5. the absence of surveillance by peak flow measurements, etc. The socio-economic factors and above all the psychological factors play a role which is not negligible. A poor evaluation of the severity of the crisis by the asthmatic has been suggested as a factor, but it is possible that the rapidity of the progression of the crisis in fatal asthma may be responsible for the physical inability of the patient to react to the situation. There is no reason to incriminate beta-mimetic agents in fatal asthma. The prevention rests on an improvement in treatment, the education of the asthmatic and an improvement in medical teaching. However, only improvement in the speed of admission of emergency cases will effectively permit a reduction in the incidence of fatal asthma. The system of auto-admission of patients at risk should be reserved for co-operative patients but the systematic medicalization for urgent cases of asthma merits further development. A better definition of the asthmatic population at risk for fatal asthma is necessary.