Two girls with asthma died suddenly in autumn-winter 1985. On clinical criteria, both had been classified as moderately severe asthmatics, had shown a stabilised disease course, and had complied with antiasthmatic medication. By chance, lung function, bronchial reactivity, and subjective perception of lung function impairment had been assessed five and a half months and one month before death, respectively. For comparative purposes, we measured lung function and bronchial reactivity in a reference group of 37 children who had asthma of the same clinical severity and who were taking the same medication. In comparison with this reference group the index subjects showed a high degree of bronchial reactivity, incomplete recovery of function after bronchodilation, and appreciably reduced perception of severe lung function impairment. Regular assessment of lung function, bronchial reactivity, and perception of breathlessness might help to identify the patient who is prone to a fatal attack of asthma.
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