Childhood asthma is a high-prevalence, multi-factorial, sometimes fatal, chronic disease that is difficult for families, particularly low-income families, to manage effectively. Rates are now higher than 25 years ago, doubling between 1980 and 1995. Prevalence is especially high for African American and Hispanic children living in inner cities. Asthma is the major admitting diagnosis for children for the University Hospital and MetroHealth systems in Cleveland.

While there are multiple factors that can contribute to the severity of asthma, it is well-established that exposures to inhalant allergens and respiratory irritants can exacerbate symptoms, increasing the frequency, severity and duration of breathing difficulties. Allergen and irritant sources include tobacco smoke, cockroaches, rodents, molds and faulty combustion appliances, all of which are especially prevalent in low-income substandard housing.

Family Asthma Management Tasks
We have identified five tasks that families must master to manage asthma:

1. Complying with medication regimens:
   Failure to fully comply with medication regimens is the chief causes of asthma exacerbations and emergency department visits. Due to the complexity of medication regimens, lack of adherence is all-too-common.

2. Identifying and reducing environmental triggers:
   Control of relevant allergens and irritants in the home is essential for long-term asthma management. Avoiding these exposures can reduce underlying lung inflammation, breathing difficulties and need for medication. However, controlling asthma triggers in substandard housing is a challenging task for families.

3. Anticipating and coping with attacks:
   If families have a good understanding of the asthma disease process and have the observational skills to recognize the signs and symptoms of worsening asthma, they may be able to prevent an exacerbation or reduce its severity and duration. The family will also be better prepared to cope with an attack. If breathing worsens severely it can be life-threatening, so parents/caregivers need to be able to recognize the crisis and take appropriate action in an emergency situation.

4. Navigating the health care system:
   Understanding the health care system and having the communication skills to convey questions, concerns, information and observations to the health care provider are crucial for asthma management. Parents need to know when to seek medical treatment, in which setting and with what urgency.

5. Communicating with childcare and school:
   School and childcare staff should have the individualized asthma action plan for each child with asthma in their care. They should also have the child’s rescue medication or give the child permission to carry a rescue inhaler. Parents need the understanding and communication skills to deal with school or childcare about their child’s asthma.