Studies have suggested increases in hospitalization for asthma and in asthma mortality during the early 1980s. Using US Vital Records, we examined asthma mortality from 1968 through 1987 to describe the rates of change among children and young adults (aged 5 to 34 years) with time and in small geographic areas. During the 1970s, US asthma mortality declined by 7.8% per annum ( ± 1.0%), declining faster among women and nonwhites. During the 1980s, mortality increased by 6.2% per annum ( ± 1.2%), increasing faster among those aged 5 to 14 years than among those aged 15 to 34 years. Small-area geographic analysis revealed four areas with persistently high asthma mortality. Neither changes in International Classification of Diseases coding nor improved recognition of asthma, as demonstrated by trends in autopsy rates or rates of in-hospital deaths, seems to explain the increasing mortality of the 1980s.