OBJECTIVE: To describe the asthma-related pharmacotherapy utilization following a first and second morbid event for asthma among children and adolescents enrolled in Medicaid. METHODS: Medicaid hospitalization and emergency room (ER) claims with a primary ICD-9 CM diagnosis code for asthma dated 2002 were extracted for recipients less than 21 years of age. The corresponding asthma-related prescription claims also were extracted. Recipients with at least two morbid events (defined as two consecutive ER or hospital visits at least 8 days apart) formed the study cohort. Pharmacotherapy use for each recipient was analyzed for up to a 30-day period following his/her first and second morbid event. RESULTS: A total of 214 recipients was identified as the study cohort consisting mainly of infants less than 6 years of age (50.0%), males (61.7%), and whites (82.2%). The proportion of recipients who filled a prescription for a controller medication following the second event was greater than the proportion following the first event (40.2% versus 34.1%). A greater proportion of recipients used leukotriene modifiers (24.3%) and inhaled corticosteroids (20.1%) than other controller drug classes following the first event, as well as following the second event (25.7% and 21.0%, respectively). Following the first event, 59.6% of recipients who used a leukotriene modifier continued using the same medication after the second event, compared to only 27.9% of recipients who used inhaled corticosteroids. With respect to demographic groups, there was a very low proportion of recipients who were black who used controller pharmacotherapy following the first (14.7%) and second event (23.5%). CONCLUSION: Although there was an increase in the proportion of recipients who utilized controller pharmacotherapy after a second morbid event, there was a low use of these medications overall. Among demographic groups, blacks had the lowest utilization of controller medications following morbid events.