The authors used a visual grading of severity, the supraglottic index (SGI), described in the otolaryngoscopy literature,8 to assess the inflammatory changes in the upper airway caused by proximal GERD. The scoring of the supraglottic abnormalities identified 34 of 35 patients with GERD who were positively identified by esophageal pH studies. With intense medical treatment, most asthma symptoms and lung function improved; however, some patients required Nissen fundoplication to achieve improvement. Using conventional culture and polymerase chain reaction techniques from BAL, endobronchial biopsy, or endobronchial brush, they were able to identify subacute bacterial infection in 43% of their patients. Although Mycoplasma and Chlamydophila, organisms previously implicated in asthma, were the most common infections identified, some patients had evidence of Haemophilus influenzae, Pseudomonas aeruginosa, Acinetobacter species, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus, bacteria not usually associated with poorly controlled asthma. The authors found that neutrophilia of ≥20% in BAL fluid indicated subacute bacterial infection. When <20% neutrophils were seen, infection was less likely but still possible.