Asthma morbidity and mortality, including rates of hospitalizations and emergency room visits, is rising dramatically in the US, particularly in minority, indigent populations. Our study will assess the effectiveness of a bilingual asthma education program involving children, parents and healthcare providers that will be implemented at three Parkland Memorial Hospital-affiliated Community Oriented Primary Care clinics. Asthmatic children who have been hospitalized or who have had an emergency room visit for asthma within the last five years will be randomly assigned to one of two groups: a group that receives treatment by a physician who has been educated according to the NIH Asthma Management Guidelines or a group that participates in an educational program involving the physician and a bilingual nurse educator and that incorporates regular peak flow monitoring of lung function by the child. One clinic will serve as a control where patients will receive no intervention. The outcome measures to be assessed include: frequency of asthma exacerbations, number of hospitalizations for asthma, number of emergency room visits for asthma, medication usage as determined by a medication score, asthma severity as determined by an """"""""asthma severity score"""""""" and self-management practices. All patients will be followed for one year after the intervention. Morbidity caused by asthma is a serious problem in our Dallas inner-city population as it is in other urban areas. We intend to address the social and economic factors and the health care delivery and management issues that participate in the morbidity of this population. While we will attempt to determine if a reduction in morbidity will occur by simply educating the clinic physicians according to the NIH Asthma Management Guidelines, it is more likely that we will see significant improvement only upon implementation of an intensive self-management program that includes objective pulmonary function monitoring by the patient.

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