OBJECTIVES: Asthma management guidelines suggest a stepwise therapeutic management strategy for asthma patients. This study aims to characterize the association between treatment step trajectories and patient characteristics. Additionally, the association between asthma health outcomes with treatment step trajectories is assessed. METHODS:  A retrospective cohort study between Jan. 2006 through Dec. 2013 using a random sample from IMS PharMetrics Plus claims database of asthma patients in the United States aged between 6 and 64 at index. The primary outcomes of interest are treatment step (ordinal: guideline-based steps 0 (mild) to 5 (severe)) and asthma exacerbation events categorized as dichotomous and nominal (asthma-related hospitalizations, emergency room visits, and oral steroid bursts). Data was modeled using a generalized linear mixed model (GzLMM) framework for both outcomes of interests. A priori selection of covariates of interest were age, gender, Charlson Comorbidity Index (CCI), region and insurance type. RESULTS:  There was a statistically significant association between treatment steps and time since index date, baseline age, gender, and CCI (p<0.05) under a proportional odds model. The generalized logit model indicates that treatment step 2 subjects have an overall lower odds of asthma hospitalization event compared to those on treatment steps 1,3,4 and 5 (i.e. 0.064 vs. 0.106, 0.095, 0.110, and 0.222 times lower odds of hospitalization compared to no event, respectively). Females compared to males had a higher asthma exacerbation event (1, 2, 3, and 4) odds (1.914, 1.133, 1.297, and 1.253) compared to no event. Patients with 1 unit increase in CCI value have a higher odds of event 1, 3, and 4 compared to no event. CONCLUSIONS:  The longitudinal analysis of asthma treatment steps identified many significant associations between treatment steps and patient characteristics such as baseline age, CCI, and gender. Additionally, patients with higher CCI values and females (compared to males) had higher odds of exacerbation events.