Asthma mortality has been increasing over the past 15 years. Since the incidence of fatal asthma is rare, death is perceived as an unexpected outcome. This paper reviews the nature of asthma, and the circumstances and characteristics of patients with fatal asthma attacks. In light of these features, the emergency care of acute asthma is discussed. Recommendations for improvement of prehospital and hospital care are made. Despite optimum therapy and management, death is sometimes unavoidable.