Background: Influenza is an important cause of epidemic and pandemic disease leading to mortality and morbidity in children. Despite great efforts to increase influenza vaccination, many children with chronic medical conditions do not receive influenza vaccine. Our aim was to identify the demographic factors and asthma-associated characteristics related to vaccination, caregivers' attitudes and knowledge about influenza disease during the 2007-2008 influenza season. Methods: Caregivers of children with asthma were surveyed via a self-administered questionnaire to document their knowledge about influenza disease and vaccine and factors influencing vaccination. Results: We enrolled 311 children with asthma. The rate of lifetime influenza vaccination was 69.5%, whereas 51.8% of the patients had been vaccinated in the current season. There were no significant differences in demographic factors and asthma control parameters between the groups who received or did not receive influenza vaccine. Most of the parents whose children were vaccinated believed that influenza vaccination would decrease the prevalence and severity of asthma attacks (P < 0.05). The most important reason cited by parents for deciding on the influenza vaccine for their child was physician recommendation (80.1%). The major reasons for declining the vaccination were unawareness that the influenza vaccine was a requirement for their child (29.3%) and illness at the time of vaccination (20%). Conclusion: Physician recommendation is important in the influenza vaccination decision. Demographic factors and asthma control parameters had no influence on immunization uptake but parental beliefs and attitudes could be determinant. Greater effort is needed to increase influenza vaccination rates, in children with asthma. Pediatr Pulmonol. 2011; 46:139-144. (C) 2011 Wiley-Liss, Inc.