Epidemiological studies report an increase in asthma mortality rates (AMR) in Great Britain, Western Europe, and the United States from 1978 to 1984. Certificates of asthma deaths (ADS) from Massachusetts were reviewed from 1971 to 1986. Massachusetts "death tapes" record name, age, sex, and race of decedent, date and place of death (hospital, enroute, home), and if an autopsy was performed. There were 950 ADS from 1971 to 1986. Females outnumbered males by 3:2. The AMR was stable from 1970 to 1979. After 1979, AMR increased more than two-fold from 0.66 to 1.80/100,000 population. There were only 4 deaths under age 4. AMR in the 5–34 year-old age group remained unchanged from 1971 to 1986. Childhood ADS (0–14 years) are more common in females. There is a slight increase in ADS in the 30–65 year-old age group. The greatest increase after 1979 is seen in elderly females ≧ 65 (two to threefold). There was no increase in ADS in black males or females. Blacks make up a higher percentage of ADS in 5–34 year olds (28%) as opposed to whites ≧ 65 (2%). 53% of ADS occur in hospital (DOA or enroute 31%, at home 16%). Young blacks were more likely to die outside hospital. There was an alarming increase in ADS outside hospital in 1984 and 1985–11 of 13 deaths. Autopsy material is readily available since 12 of 13 deaths in 1984–1985 were autopsied. This observable increase in AMR in Massachusetts may be due to diagnostic artifact or physician bias, where elderly females (≧ 65) with wheezing (or chest congestion) are coded as an asthma death as opposed to elderly males and smokers, who are coded as a COPD death.