Asthma is a chronic heterogeneous condition of the airway and is prevalent in large number of Canadian children and adolescents. Despite the existence of evidence-based treatment guidelines, the management of asthma remains suboptimal, and many patients continue to experience ‘uncontrolled’ asthma. The aim of this study was to describe the prescribing pattern of asthma-related drugs (anti-asthmatic medications, inhalational devices, antibiotics, vaccines) among children and adolescents and examine the clinical consequences of inappropriate prescribing and lack of prescribers’ adherence to expert treatment recommendations (Global Initiative for Asthma (GINA) guidelines). A retrospective longitudinal descriptive cohort study spanning 2013-2017 was conducted using health administrative data from Manitoba Centre for Health Policy (MCHP). Out of 25,732 patients receiving anti-asthmatic prescriptions with a physician confirmed asthma diagnosis, 7140 constituted the cohort of newly treated persistent asthma patients. Two-year treatment follow-up from their index date revealed that 45.53% of them failed to take any anti-asthmatic medications in their second year. Antibiotic prescriptions, particularly broad-spectrum antibiotics was common among patients with asthma as compared to non-asthmatic matched controls and were mainly prescribed for Upper Respiratory Tract Infections (URTI). Multivariate logistic regression analysis indicated that non-compliant prescriptions defined against the expert treatment recommendations from GINA were not associated with any risk of exacerbation in two years, however patients with notable overuse of Short-Acting β-Agonist (SABA) [adjusted Odds Ratio (aOR) : 1.25 (1.07-1.46) -first year; 1.57 (1.19-2.06)-second year] and lower (<50%) Inhaled Cortico Steroids to total asthma drug ratio (ICS/R03) [aOR: 2.10 (1.73-2.52)-first year; 2.50 (1.84-3.39)- second year] in both the follow-up years had higher likelihood of experiencing asthma exacerbations.