Background: Asthma, a heterogeneous disease with genetic and environmental factors interplay. High dose inhaled corticosteroids recommended for severe asthma. However, global data on medicine use and outcomes is limited Purpose: To identify asthma control predictors in one-year Eastern African cohort Design: Multicounty prospective cohort study design was used in three specialized hospitals. Asthmatic patients were followed for one year with standard treatment of care. The primary outcome was asthma control level and its predictors during follow-up. A generalized linear mixed model was used to determine predictors of asthma control. Result: Of 1521 study participants 1074 (71%) were female. Controller medicines most frequently used were budesonide with formoterol inhalers and fluticasone propionate. During follow-up participants medicines adherence rate were high, medium and low, 69%, 21%, and 10% respectively. Asthma control during follow-up was 68% (95% CI: 66.66, 68.55) representing 47% improvement compared to the baseline. High level of adherence (p<0.001), low dose fluticasone (p<0.001), higher budesonide doses (p<0.001) were associated with increased asthma control. High dose of fluticasone propionate (p<0.001) and low dose budesonide + formoterol (p<0.001) were negatively associated with asthma control. Despite high adherence, 35% of participants failed to control their asthma. Conclusion: The study demonstrated significant improvements in asthma control during follow-up. Study participants who received low dose had six-fold greater odds of having well-controlled asthma. High adherence demonstrated a two-fold asthma controlled compared to low. Implications: Despite improved asthma control over time, one-third of participants remained uncontrolled, underscoring personalized treatment needs. The finding suggests reconsidering corticosteroid doses. Key Words: Asthma, Asthma Control, Eastern Africa, Pharmacotherapy, Predictors