Studies have shown an association between increased use of ?2 agonists and risk of death. Little information is available on the appropriateness of asthma management in Medicaid populations although data suggest that Medicaid recipients experience higher healthcare utilization than non-Medicaid recipients. OBJECTIVE: To determine whether Medicaid s high dose ?2 agonists (HDB) users (>1 inhaler/month) are being managed according to National Institute of Health (NIH) asthma guidelines. METHODS: All Connecticut Medicaid pharmacy claims from April to December 1998 were examined. Subjects were included if they had an asthma diagnosis and were > 5 years old. Subjects were excluded if they had chronic obstructive airway disease or a claim for ipratropium. The percent of HDB users receiving (1) no long-term controller (LTC=inhaled corticosteroid, theophylline, leukotriene modifier, mast cell stabilizer); (2) low doses of a LTC; (3) oral or nebulized ?2 agonists; (4) spacers or peak flow meters was determined. RESULTS: A total of 1596 profiles were included (42 16 years,mean S.D.;79% female); 178 were excluded. Fourteen percent were HDB users; of these 24% did not have a claim for a LTC and 29% received low doses of a LTC. Oral or nebulized ?2 agonists claims were submitted by 34% of HDB users. Seven percent and 0% of HDB users submitted claims for spacers and peak flow meters, respectively. CONCLUSION: A high proportion of Medicaid asthma patients who are HDB users are not being managed according to recent NIH guidelines. Intervention programs designed to improve adherence to the guidelines will be developed.