[From asthma attack to fatal asthma in children]

Mortality by asthma has decreased, but the number of children being hospitalized is stable: 10% of the asthmatic children are hospitalized within the year, or will be at least once before their tenth year. Some factors are associated with occurrence of a severe asthma attack: poor lung function, bronchial hyperreactivity or poor asthma control, a food allergy, a decreased perception of airway obstruction prior hospitalisation, denial of illness, psychological and social difficulties. The prevention of most asthma exacerbations is possible. The treatment must be adapted to severity of asthma: inhaled steroids, even low doses, have been proven efficient. The follow-up must be regular: planned consultations, repeated lung function testing. Educational programs show an increased quality of life, therapeutic adherence or reduction of hospitalization. The patient and care giver must be able to recognize the signs of severity of asthma exacerbation; an exacerbation is considered severe if it begins suddenly, if its progression or symptoms are unusual, and therefore requires a prompt adapted treatment. An action plan and accessible emergency care are essential.