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Background:  Appropriate management of asthma symptoms has been shown to improve a patient’s quality of life (QOL). Clinically is it important to understand mediators of this relationship so interventions can be developed. Functional status has been identified by Wilson and Cleary as a mediator of the relationship between symptoms and quality of life. The purpose of this analysis was to examine the mediation relationship between symptoms, quality of life (emotional function) and functional status (activity limitations) which are hypothesized to be indicators of health-related quality of life (HRQOL) in childhood asthma. Methods:  Sample (n=326) included children (age 7-17) who completed the Pediatric Asthma Quality of Life Questionnaire during their baseline Breathmobile clinic visit. This questionnaire contained sub-scales measuring activity limitations (5 items), symptoms (10 items), and emotional function (8 items). Composites of mean scores were used in Mplus to test the mediation model.  Results:  The hypothesized relationship between symptoms to emotional function (estimate = 0.688, S.E. =0.047), symptoms to activity limitation (estimate 0.718, S.E. = 0.046), and activity limitation to emotional function (estimate 0.241, S.E. = 0.043) were supported. As the number of symptoms increased the level of worry about emotional function and activity limitations increased. In the mediation model both direct and indirect effects of symptoms were significant. The indirect effect (mediated effect) indicated another process, different from the direct effect. Conclusion: Understanding the role of functional health through mediation analysis assists clinicians to better assess the success or failure of their interventions. Although improving the QOL of a child living with asthma, through symptom management is important, clinicians must also consider improving one’s functional health.