Despite the dramatic success of inhaled steroids in controlling asthma symptoms there remains a small number ofpatients in whom asthma can only be treated with continuous oral steroids. Eighteen such patients, aged 19–62 years (seven males, 11 females) were followed in an open trial of nebulized budesonide over 12–18 months. All had required at least 7.5 mg or more daily prednisolone to control their symptoms over the preceeding 2 or more years and were taking 1200/μg beclomethasone dipropionate or 1600/μg budesonide daily. With a daily dose ranging between 4 and 8 mg nebulized budesonide, 14 patients successfully stopped oral steroids while in three the dose was reduced; only one patient failed to benefit. There was an increase in the mean FEV 1 from 1.9 (±0.9) to 2.2 (±0.9) 1, and in the mean morning PEFR, from 238 (±119) to 286 (±130) 1 min −1. There was also a significant decrease in the mean number of hospital admissions for acute severe asthma, from 1.5 (±1.8) to 0.9 (±1.1) per year. These findings should encourage a careful and controlled evaluation of nebulized steroids as a substitute for oral steroids in this difficult group of asthmatics.