In the current issue of CHEST (see page 898), Matsuoka et al1 report on a strong association between sensitization to proteins from the fungus Trichophyton and the severity of asthma. Their report opens up an old controversy. In the 1930s, Cooke2 and others often referred to asthma presenting in adults as “infectious” rather than “intrinsic.” At that time, both bacterial and fungal infections were thought to be relevant to the occurrence of severe asthma in adults. Wise and Sulzberger3 argued further that onychomycosis was an important cause of sensitization associated with urticaria, sinus disease, or asthma. However, when Rackemann4 described intrinsic asthma in 1948, the term was taken to be synonymous with “idiopathic” asthma. Subsequent to those conflicting views, many asthma specialists became nihilistic about the investigation of specific causes of asthma in adults. Despite this, there are now several well-recognized forms of adult asthma for which specific treatments are recommended. These include Samters triad and allergic bronchopulmonary aspergillosis (ABPA), as well as perennial asthma in patients with sensitization to indoor allergens.5,6 Vocal cord dysfunction should also be included among those forms of asthma with an etiologic basis because, though the mechanism of obstruction is very different, this condition is often misdiagnosed and treated inappropriately with oral steroids. Collectively, an important and unifying feature is that each of these types of asthma can benefit from different treatments.