Asthma mortality rates were very stable, and very low, in Western countries during the first half of this century. However, there were asthma mortality epidemics in six Western countries in the 1960s. These were linked with the introduction of isoprenaline forte which was only marketed in the six epidemic coon tries (England and Wales, Scotland, Ireland, Norway, Australia and New Zealand), and in two other countries for whom sales were low (The Netherlands and Belgium). Although the high-dose (forte) formulation of isoprenaline was not marketed in Japan, and the country showed only a modest increase in asthma mortality in the 5-34 years age-group, there was a more marked increase in mortality in the 10-414 years age-group which paralleled the increase in total sales of beta-agonise aerosols. A second mortality epidemic occurred in New Zealand in the 1970s. This was linked with the introduction of fenoterol, which was not licensed in the USA and had a low market share in most other countries. Japan experienced a doubling in asthma deaths in the 5-34years age-group following the introduction of fenoterol in 1985, and there was a parallel between the increase in fenoterol sales and the increase in mortality. Fur thermore, a recent study found that a high proportion of asthma deaths were in persons prescribed fenoterol (53% compared with a market share of 18%). Thus, the available data for Japan is consistent with the studies in Western countries that have indicated an increase in the risk of asthma death in pa tients prescribed isoprenaline or fenoterol, which are both poorly selective full agonists that were market ed in high dose preparations. These findings have policy implications for Japan and the Asia Pacific region, as well as for the rest of the world.