BACKGROUND: HRQoL in children with asthma depends on multiple factors, among which asthma severity and level of control are believed to play a vital role. The determinants of the connection between asthma severity and asthma control with quality of life remain unclear.AIMS: Primary aim of the study was to evaluate the HRQoL in children with asthma and to determine the factors that affect it.MATERIALS AND METHODS: In total 504 children and one of their parents were recruited during a regular follow up visit in an outpatient asthma clinic. The measures used were the DISABKIDS smiley measure (DSmM), chronic generic measure-long form (DCGM-37) and the Condition-specific modules for asthma along with a special form for collecting demographic and clinical characteristics.RESULTS: Three hundred fifteen children with mean age 5.35 years (Group A) and 189 with mean age 10.79 years (Group B), were recruited. Children with controlled asthma had significant higher mean score than the other asthma control groups (P < 0.001). Corticosteroid use, asthma severity, number of visits in doctor's office and lack of asthma control were significantly associated with the DCGM-37 scores as well as Impact Scale and Worry Scale. Lack of Asthma Control was the only factor that was associated with negative HRQoL in all the multiple regression models, controlling for the effect of the other covariates, in both age groups.CONCLUSIONS: In conclusion, the evaluation of asthma HRQoL independently reflects the asthma control state and a dimension of its severity. These results highlight the need to modify asthma management strategy.