Although asthma deaths in children are rare, most asthma deaths should be preventable. No information has been identified in the professional literature addressing the occurrence of asthma deaths in schools. This investigation identified asthma deaths that occurred in US schools between 1990 and 2003 and the circumstances surrounding those deaths. Data were obtained through newspaper articles in the LexisNexis database and death certificates. Between 1990 and 2003, 38 asthma school deaths were reported. Eighteen (47%) identified deaths occurred among black children and 12 (31%) among white. Twenty-seven (72%) of the deaths occurred among teens. Of the fatal asthma attacks, 16 (42%) occurred while the children were participating in a physically active event. Twelve (31%) children died while waiting for medical assistance. Due to the nature of these data, inferences may be subject to source bias. For the identified asthma deaths, key findings include the following: (1) most deaths occurred in teens and high school students; (2) frequently, the precipitating event was related in time to exercise: and (3) a delayed response or hesitancy of school staff to provide medical assistance may have contributed to some of the deaths. Although few school-related asthma deaths are reported each year, the true number is unknown. Key factors in managing the disease and preventing asthma deaths and exacerbations in schools include identification of students with diagnosed asthma, communication with parents and health care providers, removal of triggers in the immediate school environment, and maximizing access to needed medications.