Purpose: The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR-I) examined patients with severe/difficult-to-treat asthma. TENOR-II evaluated the natural history of this cohort >10 years later. This analysis assessed the long-term outcomes of pediatric patients from TENOR-I, who were enrolled in TENOR-II as adults. Methods: TENOR-II (n=341) was a multicenter, observational study with a single follow-up visit. The pediatric subgroup (33/341) included patients who were < 18 years old at TENOR-I enrollment and were ≥18 years at TENOR II enrollment. Clinical outcomes of pediatric patients assessed at TENOR-I were examined at TENOR-II. Results: Mean (SD) age of the pediatric subgroup at TENOR-I and TENOR-II was 11.0 (2.8) and 24.1 (2.6) years, respectively. While the total IgE geometric mean (95% CI) decreased between TENOR-I and TENOR-II (177.6 [107.9, 292.3] versus 79.9 [29.3, 217.5], respectively), 83.9% of patients tested positive for any specific IgE in TENOR-II. Pre-bronchodilator percent predicted forced expiratory volume in 1 s (ppFEV1) was 91.7 (21.3) in TENOR-I versus 86.2 (14.9) in TENOR-II. The proportion of pediatric patients with very poorly controlled asthma, based on NHLBI asthma guidelines, was 48.5% in TENOR-I and 36.4% in TENOR-II, not well controlled asthma was 51.5% in TENOR-I and 42.4% in TENOR-II; well controlled asthma was 0.0% in TENOR-I and 21.2% in TENOR-II. Exacerbations three months prior to enrollment were more frequent at TENOR-I than TENOR-II (39.4% versus 3.0%, respectively). Conclusion: Findings from the pediatric subgroup of TENOR-I after >10 years suggest some improvement in asthma control and exacerbations despite lung function decline. However, a high proportion of patients had allergic sensitivity, majority had uncontrolled asthma.