Background: Asthma is the most common chronic disease among children today, yet surveillance is limited to national and state estimates which can vary over time, by location and by population types. This article describes a comprehensive statewide school-based asthma surveillance program and examines 5?years of surveillance data. Methods: After pilot testing, a 1-page survey was mailed to school nurses in all public, private, and charter schools in Massachusetts. Variables measured included the number of students with a diagnosis of asthma by sex, grade (K-8), race/ethnicity by school and by community of residence. Results: The participation rate increased each year, and by the 5th year it was nearly 100%. The reported asthma prevalence was 10.6% (averaged for the 5-year period) and noted to be higher among males each year. Conclusions: This work provides evidence that a school-based pediatric asthma surveillance system can be developed and successfully implemented. The feasibility of using school health records, as an accessible data source to readily identify asthma cases can provide reliable aggregate community-based pediatric asthma prevalence information.