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A service for 300 adult asthmatics is described. Since the service was started in 1970 only one death has occurred and this patient failed to comply with treatment or advice. Two patients required intermittent positive pressure ventilation. The success of the service is founded on two facts. Firstly, the natural history of life-threatening asthma usually allowed time to change treatment at home or in a clinic and this prevented the development of the severe grades. Secondly, the great majority of asthmatics could be taught how to recognise worsening of their asthma and to communicate with a doctor who then changed the treatment. An essential feature of the service is that the patients had at all times easy access to a doctor with appropriate knowledge and attitudes.

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