Death from asthma in childhood is rare, occurring in approximately 1 i
n 10 000 affected children. While most deaths occur in hospitalised ch
ildren with severe asthma, it has been reported that sudden and unexpe
cted death may occur in children with only mild disease. In this study
the clinicopathological features of 11 cases of sudden death taken fr
om the files of the Adelaide Children's Hospital over a 30-year period
are reported. Children were aged between 3 years 10 months and 15 yea
rs 2 months (average = 9 years 9 months), with a male to female ratio
of 5:6. Deaths occurred either at home, in an ambulance or within minu
tes of arriving in the Emergency Department. Viral respiratory tract i
nfections were common associated findings. While one child was conside
red to have only mild disease, most children had long histories of ast
hma and had required prolonged medication or hospitalisation. The demo
nstration of growth retardation (i.e. height or weight < 3rd percentil
e) in 73% of cases is also supportive of long-standing severe asthma b
eing present. Thus, in this series, sudden and unexpected death occurr
ed only in children with significant chronic disease. In formulating t
he diagnosis of sudden death due to asthma in children, delaying growt
h parameters may, therefore, be an additional useful morphological mar
ker indicating an at-risk child.