OBJECTIVES:  To estimate health care utilization and direct costs of asthma in Colombia from the health care system perspective METHODS: A retrospective prevalence-based study was used to analyze claims data on health services utilization and costs in all-age patients with asthma (CIE-10: J45-J46) for the year 2015. Patients were identified and selected between Jan-1-2004 and Dic-31-2014 using a nationally large-scale medical claims database from a subsidized-regime insurance company that required at least 12 months of continuous insurance coverage for eligibility. Sample was divided into 4 different levels based on the Leidy criteria, an established algorithm for assessing asthma severity with claims data based in rescue medication fills. Exacerbations were included for a more accurate classification. Costs were converted to international dollars using mean exchange rate of 2015 adjusted for purchase parity power RESULTS:  Among 20,890 patients completing study criteria, 53.3% were female, mean age (SD) was 21.4 (±21.6) years. In regard to severity of symptoms, 69.9% had mild intermittent, 17.8% mild persistent, 6.7% moderate persistent and 5.4% severe persistent asthma. The most common co-morbidities were chronic obstructive pulmonary disease (n=2,251; 10.8%) and rhinitis (n=1,222; 5.9%). Overall median (IQR) cost per patient was $60.8(137.1). According to severity, cost were $35.1(57.6), $181.7(273.5), $481.1(1,026), $1,205.2(2,149) in level 1-4 respectively (p<0.001). Relative frequencies of prescriptions and services were: oral corticosteroids, 19.5%; inhaled corticosteroids, 24.5%; inhaled corticosteroids-long-acting B2-agonists combination, 2.3%; hospitalizations, 5.5%; ambulatory services, 34.5%; specialist outpatient visits, 27.6%; general physician visits, 55.7% and emergency department visits (ED), 3.4%. Median cost of ED visits and hospitalizations were $165.2(36.8) and $904.6(1,478.5), respectively. CONCLUSIONS:  Health service utilization and direct costs of asthma in Colombia are high and related to severity of symptoms. Nationwide health policies aimed at the effective control of asthma are necessary and will play an important role in reducing the associated economic impact.