**5. Severity**

Numerous studies have shown that inner city asthma, especially among children, is charac‐ terized by increased intensity and poor response to therapy [39]. It is not clear why this population of asthmatics is more difficult to control. Some investigators speculate that a myriad of factors may be involved including environmental, socioeconomic, psychosocial, behavioral, or genetic ones [39, 40]. Other authorities believe that the poor control may be related to inappropriate asthma management practices, limited access to care, poor compliance with therapy, and limited communication between physicians and patients [41, 42]. The practical implications of these observations are that these children have a higher rate of hospital admissions [43] and their condition at the time admission is serious and is frequently described as near fatal [44] which refers to a group of individuals predisposed to acute respiratory failure from their disease state with acidosis and altered mental status.

The increased acuity of inner city asthma has several short-term and long-term implications. The collective cost resulting from loss of work and productivity as well as absenteeism from school and work is hard to measure. The added cost of overutilization of healthcare facilities and emergency department adds to the financial implications of this phenomenon. Overcon‐ sumption of pharmaceutical agents and other supportive agents and procedures further increases the overall cost. Finally, the impact on the general health of the individuals, stunted growth, and development of long-term respiratory impairment adds to the overall societal impact.
