OBJECTIVES: Examine outcomes and costs for persistent asthma patients who initiated therapy with beclomethasone dipropionate (BD) or fluticasone propionate (FP). METHODS: MedStat's Commercial Claims and Encounter Database (July 1, 2002 – June 30, 2007) was utilized. Patients who initiated therapy with BD or FP (first use=index date) and met the following criteria: a) no receipt of other study medication in the 1 year post-period; b) persistent asthma in the 1 year pre-period; c) age 5-64; d) no diagnosis of COPD; and e) continuous insurance coverage from 1 year pre through 1 year post-period were included. Multivariate regressions (N=13,968) examined the probability of an ER visit or hospitalization, probability of reaching alternative adherence thresholds and annual costs. RESULTS: Receipt of BD, compared to FP, was associated with a 17% reduction in the odds of an ER visit (OR=0.834, 95% CI 0.751-0.925), 30% reduction in the odds of an asthma-related ER visit (OR=0.697, 95% CI 0.571-0.852), as well as a significant increase in the odds of obtaining a medication possession ratio (MPR) of at least 50% (OR=1.324; 95% CI 1.164-1.506) or 75% (OR=1.311; 95% CI 1.072-1.604). Total medical costs ($5,063 v $5,377, p=0.0042), drug costs ($2336 vs. $2581, P<0.0001) and ER costs ($185 vs. $249, p<0.0001) were significantly lower among the BD cohort. Asthma-related outpatient ($191 vs. $224, P<0.0001) and ER costs ($28 vs. $45, P<0.001) were significantly lower in the BD group while asthma-related inpatient ($59 vs. $101 P<0.0001) and drug costs ($451 vs. $540, P<0.0001) were significantly lower in the FP cohort. CONCLUSIONS: Results indicate that receipt of BD, compared to receipt of FP, is associated with a decreased probability of ER visits or asthma-related ER visits, and higher odds of reaching a MPR threshold of 0.50 or 0.75. Receipt of BD was also associated with lower annual total medical and drug costs.