There is now a reasonable body of data that would suggest that the immunopa
thology of asthma is similar, if not identical, in childhood asthmatics com
pared with adult asthmatics. Indeed, we now have evidence that much of the
immunopathology is established within the airways of asthmatics very early
after the onset of symptoms and, given the lack of correlation with duratio
n of symptoms, may even antedate the first manifestations. There are, howev
er, some differences with neutrophil recruitment being somewhat more promin
ent than has been recorded from adult observations. The utility of any infl
ammation parameter in identifying the real future asthmatics has yet to be
studied in sufficient detail to define sensitivity, specificity and predict
ive value. Such studies will be an essential prerequisite to establishing v
ery early intervention strategies, particularly if these involve the use of
inhaled and/or oral corticosteroid.