OBJECTIVES: Asthma prevalence, morbidity and mortality have continued to increase in the United States over the last decades. Disease management programs for asthma have become a priority for managed care organizations (MCOs) in order to optimize the process of care, manage utilization, and improve outcomes. The objective of this study was to investigate how MCOs currently approach asthma treatment and management and to identify their biggest challenges and opportunities in improving asthma outcomes, and to determine if publication of revised asthma guidelines by the National Heart, Lung and Blood Institute (NHLBI) in 2007 changed MCOs’ approach to asthma management. METHODS: A web and paper-based survey tool was updated from a previous survey whose results were published in 2005, and administered to a national sample of 383 MCO medical directors Descriptive statistics were calculated for all variables. RESULTS: All 61 (15.9%) responding medical directors collectively serve all regions of the United States, with almost half serving Medicare and/or Medicaid patients. All directors surveyed reported that their organizations monitor asthma patients. Plans use a variety of asthma management activities, including self-management education (80%), educational materials by mail (70%), general member education (65%) and behavior modification programs (60%).  Most commonly cited factors impeding the provision of effective asthma care were noncompliance with asthma treatment, the inappropriate use of medications, and the need for multiple medications. Descriptive comparisons show that results are very similar to those from the 2005 survey. CONCLUSIONS: Survey results show that health plans rely on an array of strategies to manage asthma patients. Education appears to be an essential part of most plans’ approaches to disease and cost management. Comparing our results to those reported in the 2005 study, the 2007 NHLBI guidelines appear to not have greatly impacted the approach MCO’s take towards asthma management.