Bronchial asthma is a significant health problem in the United States and this is particularly true for the pediatric population. The prevalence of asthma, asthma mortality and morbidity and the increase in mortality and morbidity are significantly higher in low income inner-city Black children than in other pediatric socioeconomic groups. This two phase proposal is designed to compare inner-city Black asthmatics with inner-city White asthmatics, noninner-city Black and White asthmatics and inner-city nonasthmatics to identify socioeconomic, psychological, familial, environmental and clinical factors which impact upon Black inner-city asthmatics aged 4 to 11 and contribute to increased asthma morbidity and mortality (Phase I). Based upon the Phase I data, we will design and implement a comprehensive asthma management program including: a) State of the Art Medical Care in clinical settings, b) Professional Outreach to patients and their families and c) Community Organization to promote asthma self management. Inner-city Black asthmatics receiving State of the Art Medical Care and Professional Outreach or State of the Art Medical Care, Professional Outreach and Community Organization will be compared among themselves and with inner-city and suburban asthmatics who do not participate in the asthma management program. This unique collaboration of two major medical centers acting as equal partners and encompassing 5 clinical settings should help to identify the major factors contributing to asthma morbidity and mortality in the inner-city and suggest methods for asthma management to overcome the impediment to asthma care.
