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Previous studies have shown high levels of psychological morbidity in patients who had SLTA or who died of asthma ; these findings have now been extended to include those admitted with acute asthma . However, in a case control study, no differences were found in any specific psychological parameters between those with SLTA and those admitted to hospital with acute asthma , similar to the results of Boulet et al . While individual psychological factors may not be risk factors, a gestalt assessment of psychosocial dysfunction, as used by Rea et al , has been shown to be a risk factor for asthma death. Nevertheless, psychological morbidity (anxiety, depression, and total and certain life events) was significantly higher in those admitted to hospital in comparison with community-based patients with asthma or asthma clinic attendees . Thus high levels of psychological morbidity exist, particularly in patients with asthma with severe disease and/or high morbidity.