Reducing Deaths Caused by Bronchial Asthma

To the Editor.—

Strunk et al¹retrospectively compared the psychological and physiological characteristics of two groups of children with severe bronchial asthma, those who died vs those who did not. The national figures for all deaths from asthma are 2,326 deaths in 1972, 1,876 in 1974, 1,975 in 1976, 1,872 in 1978, 2,891 in 1980, and 3,154 in 1982 (National Center for Health Statistics, written communication, 1985). The authors reported no deaths in their own hospital during this period. Nonetheless, their study unintentionally raises serious questions about patient care, especially about the follow-up plans the hospital arranged and the actual care the patients received after discharge, since patients "died in their home communities after being discharged": Many patients who went on to die had become sicker during the week prior to discharge. Why, then, did the hospital discharge them? Was follow-up care arranged within one or two