To determine whether hospital admissions for acute childhood asthma were rising in Cape Town in line with the experience of other countries, Red Cross War Memorial Children's Hospital's records for the period 1978-1990 were analysed. These were compared with total admissions for non-surgical causes and lower respiratory tract illness as well as those for bronchiolitis and pneumonia. Asthma admissions showed a sharp upward trend from 1978 to 1984, a slower rise through 1987 and a levelling off since. The profile of hospital admissions for respiratory illness was also analysed. Black children were under-represented among asthma admissions compared with those for pneumonia. Asthma admissions occurred throughout the year but showed seasonal peaks in May and November. Reasons for these trends and patterns are discussed, as well as hypotheses for further research into the epidemiology of asthma in South Africa.