OBJECTIVE: The Asthma Symptom Utility Index (ASUI) is an 11-item asthma-specific health utility instrument developed in the US. The purpose of this study was to translate and linguistically validate the ASUI for international use. METHODS: Seventeen languages were identified: Bulgarian; Chinese (Traditional and Simplified); Dutch; Finnish; French; Hebrew; Hungarian; Indonesian; Italian; Malay; Norwegian; Portuguese; Romanian; Spanish; Swedish; Turkish. The following method was used for each translation: 2 forward translations by native speakers; 1 reconciliation of the two forward translations; 1 back-translation by an English-speaker fluent in the target language; 3 reviews by independent bilingual experts, and final reconciliation by a native-speaking language coordinator. Pilot-testing and cognitive debriefing interviews were performed with 10-15 native-speaking asthma patients in 19 countries. Item and total score distributions and internal consistency levels were examined. US-derived item weights were used to estimate utility scores. RESULTS: A total of 290 patients participated in the evaluation. Mean age of the sample was 48.1 (± 16.8) years, and 60% were female. Internal consistency estimates (alpha) ranged from 0.74 to 0.90 (mean = 0.86). Mean utility scores ranged from 0.42 (± 0.20) for patients in Norway (Norwegian; n = 10) to 0.88 (± 0.12) for patients in Israel (Hebrew; n = 15). Consistent with these scores, the Norwegian sample also experienced more severe symptoms, with more than half reporting moderate to severe wheezing (5/10) or dyspnea (8/10) during the previous two weeks compared with 2/15 and 2/15 in the Israeli group, respectively. CONCLUSIONS: Results suggest the 17 ASUI translations are culturally acceptable, linguistically valid, and conceptually equivalent to the original, paving the way for international asthma-specific, utility-estimation studies.