OBJECTIVES: The prevalence rate of asthma in Malaysia is 9.2%.  Acute exacerbations resulting in unscheduled visits and hospitalizations are a burden to the healthcare resources in the country.  This study was designed to describe the treatment pattern and health outcome of asthmatic patients hospitalized after attending ED.  METHODS: A retrospective observational study was conducted.  In Phase I, all asthmatic patients with at least one ED visit for asthma (ICD-10 codes J45-J46) leading to hospitalization were included.  Inhaled corticosteroid (ICS) prescribed; asthma education, action plan and clinic follow-up given; number of asthma exacerbations (AEBA); number of unscheduled visits and medications prior to hospitalization were recorded.  In Phase II, medical records of the same patients but who had at least one follow-up visit or unscheduled visit or ED visit or hospitalization were reviewed to assess four components recommended in the asthma GINA guideline after an asthma-related ED visit. Data were collected from patient medical records, Pharmacy Information System and Hospital Information System. RESULTS: In Phase I, 194 patients were included comprising of 60.8% female and 54.6% children.  Eighty-five made unscheduled visits, 120 experienced AEBA in the past 1-year, 98 received asthma education, 194 given follow-up appointment (118 defaulted).  A total of 49.5% were either on ICS mono- or combination therapy prior to hospitalization.  In Phase II, sixty-three patients fulfilled the inclusion criteria (Children 55.6% and female 54.3%). ICS use documented an increased but was not significant (p=0.063), eighteen patients were provided with asthma education, 61 patients were given follow-up appointment and 2 were provided with an asthma action plan. The number of unscheduled visits increased significantly (p=0.018).  CONCLUSIONS:AEBA indicates the failure of asthma long-term management.  This study showed that there are still gaps in the management of asthma as reflected by the treatment pattern and outcome of asthmatic patients hospitalized after attending ED.