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A 6-year-old child known with asthma died from an asthma attack after having had severe dyspnoea which lasted for 1 day. She had been having an average of 40 salbutamol 'puffs' each day for 1 month. For the preceding 8 months she had been having just over half this number as well as fluticasone. A 13-year-old girl died of an asthma attack. Three weeks previously she had been dyspnoeic and had taken salbutamol and prednisone as well as amoxicillin at a later stage. Each year between 8 and 10 children die of an acute exacerbation of asthma in the Netherlands. There are 2 different types of acute fatal asthma: a slow type (I) and a rapidly progressing type (II). In type I there is progressive obstruction of the airways due to oedema, mucous and spasm. Type II predominantly consists of bronchoconstriction. The main risk factors are previous hospital admission with asthma and inadequate maintenance medication. Effective maintenance therapy with the correct dosage of inhalational corticosteroids administered correctly can probably stop the potentially fatal asthma type II from developing.