The inhaled corticosteroid fluticasone propionate (FP) was introduced into the Thorpewood General Practice, Norwich, U.K. in 1993 -initially in treating relatively severe asthmatics. Observed beneficial effects led to expanded use - particularly for poorly controlled asthma not responsive to increased inhaled anti-inflammatories. However, an early review suggested little advantage over existing agents (l), and FP was marketed at a price premium. The aims of this study were to investigate whether continued and expanding use of FP was justified in terms of improved clinical outcomes, and if such improvements were associated with reduced NHS costs (offsetting more expensive prescriptions). A controlled, retrospective, nonrandomized primary care audit compared clinical outcomes and asthma management costs 1 year prior to and 1 year into FP therapy.