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Influenza virus infection frequently triggers asthma exacerbation and hospitalization. Annual influenza immunization is recommended for children with chronic conditions, including those with asthma or reactive airway disease (RAD); however, <10% receive it each year.In September, 1997, we instituted a computerized staged reminder strategy for annual influenza immunization of children with asthma/RAD at the Scott and White Pediatric Clinic in Temple. A reminder letter, followed six weeks later by an autodial recall telephone message, was sent to the parent/guardian of children with asthma/RAD using the Shared Medical Systems to identify children with asthma/RAD and the Integrated Client Encounter System to record immunizations. The effect of this computerized reminder system on the influenza immunization rate of a cohort of 925 Scott and White Pediatric Clinic children with asthma/RAD was examined for the 1996 to 1997 and 1997 to 1998 influenza seasons, before and after intervention.A significant increase in influenza immunization rate from 5.4% to 32.1% occurred in all age groups, regardless of the insurance status. The medically attended acute respiratory illness rate per 100 subjects was significantly higher in vaccinated than in unvaccinated children for each of the two influenza epidemics and in the period between the two epidemics.A computerized reminder letter followed by an autodial recall telephone message is effective in increasing the influenza immunization rate of children with asthma/RAD. Children with significantly higher respiratory morbidity during and in between two influenza epidemics were more likely to be immunized after receiving written and telephone autodial reminders.