Background Our protocol for the assessment of difficult asthma includes flexible bronchoscopy FB, blood for immunology and allergy tests, pH probe and nasociliary biopsy under general anaesthesia. .

Aim We report additional findings from FB that influenced further management.

Methods Retrospective analysis of FB recording the diagnoses and treatment changes. Children with cystic fibrosis were excluded.

Results Around 300 children with asthma are seen annually in our clinic. Sixteen FBs were performed on children with difficult asthma between July 2005 and March 2008 median 6 range 216 years.

Bronchomalacia was seen in 9 of 16 56. Significant reflux was noted in 3 of 16 18 aged 515 years.

Additional information leading to new diagnosis or treatment change was gained in 94 1516. Asthma medication was discontinued in 25. Better disease management was achieved in 14 patients 87.

Conclusion Targeted onestop investigation yielded a high percentage of new information enabling better management in a difficult patient population.