Anthropogenic-sourced sulfur dioxide (SO₂) and sulfates are putative triggers for asthma attacks, however, little is known about asthma epidemiology at volcanoes. Kilauea Volcano's ongoing 30+ year eruption produces substantial sulfurous air pollution called “vog” in nearby island communities. In 2008, a new vent and lava lake formed on the volcano’s summit, thereby increasing SO₂ emissions and vog in contrast to previous levels. The aim of this study was to assess if vog exposure was associated with higher incidence of asthma attacks in exposed residents. This community-based cohort study estimated the incidence and relative risk (RR) of clinic and emergency department visits for acute exacerbations of asthma (AEA) over a 7-year period capturing low and high exposure time periods. Incidence of AEA was correlated (r = +.58, p = .02) with ambient SO₂ levels in the exposed community preceding and during the summit eruption. Epidemiologic estimates were standardized for age and gender, revealing a 3-fold elevated risk (RR = 3.22 [95% confidence interval 2.59-4.01]) for AEA in the downwind exposed community. Asthmatic children living near Kīlauea suffered the highest burden of attacks relative to other age groups. Risk also increased concordant with the higher SO₂ exposure time period and geospatial pattern. Significant effect was associated with distance-from-source as observed in higher AEA incidence in residents living proximal to Kīlauea compared with those residing at more distal locations. Exposure to vog is hazardous to asthma populations due to increased risk for acute exacerbation. Repeated exacerbations plausibly lead to increased progression of asthma. Therefore, asthmatics living near active volcanoes should follow asthma management regimes. Geologists can partner with public health workers and clinicians to promote vog exposure-reducing activities that are evidence based and culturally tailored for the population, as well as feasible for each volcanic setting.