OBJECTIVES: Asthma is under-diagnosed and under-treated in elderly, and utilization of asthma medications in this population is not well characterized. This study describes utilization patterns of asthma medications in newly diagnosed ≥50 patients. METHODS: Medicare enrollees are followed for 12 months after first asthma diagnosis between Q1 2004- Q3 2012 (ICD-9-CM code: 493*). Treatment pattern analysis was applied to initiators of asthma medications. Patients with >1 prescription of second-line therapy following exposure to first-line therapy are considered therapy switchers or augmenters. Patients with history of chronic obstructive pulmonary disease are excluded (ICD-9-CM codes: 490, 491*, 492*, 494*, 495* & 496). RESULTS: Among 126,176 elderlies with asthma, 24,021 initiated asthma therapy within 12 months of asthma diagnosis (70% women, median age 70 years). 319 (1.3%) continued therapy with one drug class (first-line therapy); 13,940 (58%) discontinued first-line therapy; 3,469 (14.4%) switched to another drug class (second-line therapy); and 6,293 (26.2%) added second-line therapy (augmented). About 34% of patients initiated therapy with inhaled short-acting beta-agonists (SABA); majority of them either discontinued SABA or added a controller medication. 19% of elderly patients started with oral corticosteroids after asthma diagnosis, 77% discontinued them and 12% switched to another asthma controller. Among controller medications, inhaled corticosteroids (ICS)/long-acting beta-agonists (LABA) combination therapy, ICS monotherapy, and leukotriene antagonists respectively accounted for 19%, 12%, and 11% of treatment initiators. The majority of these anti-inflammatory formulations were discontinued during 12 months after asthma diagnosis. CONCLUSIONS: Asthma treatment utilization patterns reflect poor asthma control among newly diagnosed elderly patients, and initiation of anti-inflammatory treatment after asthma diagnosis appears to be inconsistent with asthma management guidelines.