Despite clear guidelines for management of asthma, many children, especially those living in the inner city, still receive inadequate therapy. Halterman et al conducted a randomized, controlled trial to determine whether school-based screening coupled with primary care provider notification of asthma severity would lead to better compliance with recommendations for preventive therapy. Unfortunately, the addition of the school component did not improve prescription of preventive medication, recommendations for environmental modifications, or referrals to specialty care. Half of the children had no medication changes despite still having persistent symptoms. More powerful interventions appear to be needed to ensure all children with asthma receive appropriate care.