Our objective was to determine if a different presentation of asthma among Eskimo children in southwest Alaska influenced treatment for asthma. Data regarding symptoms, medication use, and hospitalization were obtained from the medical records of 58 Eskimo children diagnosed with asthma. Half of the children also had a diagnosis of chronic lung disease (CLD), and 57% had a history of allergies. CLD was associated with significantly more visits for wheeze (P = 0.02), asthma (P < 0.005), and lower respiratory tract illnesses (P < 0.005), and a greater incidence (P < 0.005) and frequency (P < 0.005) of hospitalizations. Allergy status showed no similar relation with utilization of health services. Inhaled corticosteroids were prescribed for a minority (38%) of these asthmatic children. Allergic children tended to be more likely to receive inhaled steroids, and they received significantly more prescriptions for inhaled steroids compared to children without allergies. Those with CLD only were no more likely to receive inhaled steroids than other children, despite their higher incidence of hospitalization. Although the proportion of children with CLD or allergy did not differ significantly by village, there were significant regional differences in healthcare utilization and medication use. In conclusion, while CLD was the primary determinant of healthcare utilization among these native children with asthma, only allergic children with CLD were more likely to receive inhaled steroids. © 2004 Wiley-Liss, Inc.