Background: Pediatric asthma remains a critical public health problem, particularly in Japan, where adherence to new treatment guidelines and effective medication use are inconsistent. Therefore, we aimed to evaluate the current management practices for pediatric asthma to identify areas for improvement and enhance future treatment approaches. Methods: We conducted a web-based cross-sectional survey involving caregivers of children and adolescents aged 0–19 years diagnosed with asthma at various medical institutions in Japan. The survey focused primarily on evaluating the control status of asthma in these patients and examining factors such as treatment adherence, environmental exposure, and the presence of allergic diseases. Results: The data showed that 65.9% of the patients received some form of asthma treatment; however, a significant proportion (26.2%) still experienced poor symptom control (n=2000). The most affected group were children aged 0–3 years. The analysis showed that environmental factors and coexisting allergic diseases notably influenced poor asthma control, although direct correlations with treatment adherence were not statistically significant. Conclusion: These findings highlight the substantial gap in the effective management of pediatric asthma, particularly in very young children. Notably, pharmacotherapy is essential; however, there is an urgent need to develop comprehensive treatment plans that address environmental and lifestyle factors. Future strategies should focus on personalized care tailored to each child’s specific need, incorporating medical and non-medical interventions to optimize asthma control and improve overall health outcomes.