BACKGROUND Evaluation of a number of asthma education programs for children 8-13 has shown improved self-management behaviors and decreased use of healthcare services. However, nearly 80% of children with asthma develop symptoms by age 5. METHODS We evaluated a program (Huff and Puff: The Children's Asthma Program) that addresses the developmental learning needs of children ages 4-8. This multicenter study employed a pre- and post-test design to evaluate the impact of the Program on cognitive, behavioral, and affective learning and medical care utilization. We report here data on 128 of the 130 children who completed the program and on the 125 households on which we have nonduplicated data. RESULTS Statistically significant changes were observed in all categories of learning in those who completed the Program. Medical care utilization (including hospitalizations, days of hospitalization, emergency room visits and sick visits to the physician for "out-of-control" asthma) demonstrated statistically significant decreases. CONCLUSIONS The Program was shown to be an effective educational intervention for children 4-8 years of age and their parents in this cohort (nonrandomized, noncontrolled study of volunteers). Future research should also explore ways to utilize and adapt the program for specific populations such as inner-city children and parents and non-English speaking groups.