INTRODUCTION: Childhood asthma is a major public health problem in Colombia as in many other countries. In patients entering the second line therapy, options in the 5-11 years old category are increase corticosteroids, add LABA or add LTRA. In under five years old adding LABA is not an option. There are differences in cost and efficacy between these options, to address this issue an economic evaluation was done in the context of the National Colombian Clinical Practice Guidelines Programme in collaboration with the Colombian Pediatric Pneumonology Association. OBJECTIVES: To evaluate the cost effectiveness of the second line asthma therapy options in pediatric patients in Colombia. METHODS: A Markov model was developed including the following health states: controlled asthma, uncontrolled asthma, ambulatory exacerbation, exacerbation with hospitalization and therapeutic failure. A restringed social perspective was used (health system + out of pocket expenses) with a 3 months time horizon. Transition probabilities and utility estimates were derived from international literature and validated by a Delphi panel with local Colombian experts. Costs were provided by the Colombian MoH. A deterministic and probabilistic sensitivity analysis was performed. RESULTS: The LTRA option was dominated, being more expensive and less efficacious than increasing corticosteroids in both age categories. In the 5-11 years old the ICER comparing LABA with corticosteroids was 4.366.343 Colombian pesos (COP) per quality adjusted life week (QALW) gained.  This ICER is far above the 634.000 COP per QALW estimated for a 3 GDP threshold. In the sensitivity analysis these results probed to be robust being necessary a 4.400.000 COP per QALW of willingness to pay for the LRTA option to start being cost effective. CONCLUSIONS: Increasing corticosteroids was the most cost effective option in asthmatic pediatric population in Colombia compared to LABA, being LRTA dominated or far above the Colombian thresholds.