This report describes 15 children aged 10-35 months frequently hospitalized with uncontrolled asthma who were monitored for a mean of 26.9 months to assess the efficacy of budesonide inhalation suspension (AstraZeneca LP, Wilmington, DE) in reducing emergency interventions. Budesonide inhalation suspension was previously shown to relieve asthma symptoms, improve pulmonary function, and reduce rescue medication use in children as young as 6 months with mild to severe persistent asthma. We now show that > or = 1 year of treatment with budesonide inhalation suspension at doses between 0.25 and 1.5 mg/d decreased the burden of asthma. The mean number of hospitalizations caused by asthma or respiratory illness decreased from 1.8 +/- 1.37 in the period before initiation of treatment with budesonide inhalation suspension to 0.33 +/- 0.62 during treatment. Likewise, the mean number of oral prednisone courses decreased from 8.1 +/- 13.7 to 1.8 +/- 2.1, and the mean number of acute respiratory illnesses requiring additional therapy decreased from 2.7 +/- 2.3 before treatment with budesonide inhalation suspension to 0.87 +/- 0.74 during treatment. Numbers of emergency department visits decreased or remained the same after initiation of budesonide inhalation suspension treatment in all but two children. There was no effect on growth rate in this group of children with moderate to severe asthma. In this case series, budesonide inhalation suspension represents a safe, effective treatment option to prevent recurrent emergency intervention for patients < 3 years of age with poorly controlled asthma.