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For children living in the inner city, asthma tends to be more frequent and severe. Although the causes for this heightened severity of asthma are not clearly established, environmental allergens likely play a major role. To characterize, understand, and treat children with asthma living in the inner city better, the National Institutes of Allergy and Infectious Diseases of the National Institutes of Health established an Inner City Asthma Program in 1991. Over the past 15 years, 3 separate inner-city asthma research networks have been formed and funded by this institute. The work from these programs has led to important observations including evidence that environmental allergens, particularly cockroach, are important for sensitization and severity of asthma of the affected children. Furthermore, reductions in the allergen load can lead to improved asthma control. The most recent program, the Inner City Asthma Consortium, was formed in 2002 with a goal to develop immune-based therapy for children with asthma in the inner city and to determine mechanisms of these therapies as well as immunopathogenesis of asthma in these high-risk children. This article reviews these programs and how they have begun the effort to understand and treat children with asthma who live in inner cities better and what their findings mean in relationship to unique features of asthma in inner city children.

Background Despite growing evidence of the importance of exposure to fungi as an environmental risk factor for asthma, few data have been reported on the exposure to airborne fungi of asthmatic children living in US inner cities. Objective We sought to examine the spectrum and concentration of fungi in the air inside and outside of the homes of mold-sensitive children with asthma living in US cities. We also analyzed the relationship of the concentration of fungi in indoor air to home characteristics. Methods We performed a home environmental survey and measured the concentrations of culturable airborne fungi inside and outside the homes of 414 mold-sensitive children with asthma in 7 urban communities. Results The airborne fungi encountered indoors generally paralleled those found outdoors, and the similarities between communities were more striking than the differences. Indoor fungal concentrations were correlated with outdoor concentrations measured on the same day, suggesting the need to adjust for the outdoor concentration in analyses by using the indoor concentration as an indicator of the relative moldiness of a home. The concentration of fungi in indoor air in excess of outdoor air—that is, the indoor-outdoor difference—was significantly related to home characteristics, including dampness, having a cat, and cockroach infestation. Conclusion Mold-sensitive children with asthma living in urban communities across the US are exposed to airborne fungi in indoor and outdoor air. The concentrations of fungi are higher in homes with dampness problems, cockroach infestation, and cats. The indoor-outdoor difference in the concentration of airborne fungi may provide a valuable metric for investigations of the role of fungal exposure as a risk factor for asthma.

The article by Scott et al entitled ‘‘Achieving and maintaining asthma control in inner-city children’’ in this month’s issue of the Journal demonstrates that, through the use of mobile schoolbased clinics, guidelines-based asthma care can and is being delivered regularly and effectively to children known to have the highest degree of asthma-associated morbidity: those who reside in our inner cities. This finding is a very encouraging one because regular receipt of quality asthma care, which is often difficult in these populations, is known to be critically necessary in achieving long-term asthma control.