Background: Guidelines recommend preventive medications for all children with persistent asthma, yet young urban children often receive inadequate therapy. Th is may occur in part because primary care providers are unaware of the severity of their patients’symptoms. Objective: To determine whether systematic school- based asthma screening, coupled with primary care provider notification of asthm a severity, will prompt providers to take preventive medication action (prescribe a new preventive medication or change a current d ose). Design: Children aged 3 to 7 years with mild persistent to severe persiste nt asthma were identified at the start of the 2002-2003 school year in Rocheste r. Children were assigned randomly to a provider notification group (child’s pr imary care provider notified of asthma severity) or a control group (provider no t notified of severity). Primary care providers of children in the provider noti fication group were sent a facsimile indicating the child’s symptoms and recomm ending medication action based on national criteria. Interviewers blinded to the child’s group assignment called parents 3 to 6 months later to determine if pr eventive actions were taken. Results: Of 164 eligible children with mild persist ent or more severe asthma, 151 (92.1%) were enrolled. Children in the provider notification group were not more likely to receive a preventive medication actio n than were children in the control group (21.9%vs 26.0%; P=.57). Additional p reventive measures, including encouraging compliance with medications (33.3%vs 31.3%; P=.85), recommending environmental modifications (39.3%vs 42.4%; P=.86 ), and referrals for specialty care (6.6%vs 6.0%; P>.99), also did not differ between the provider notification and control groups. At the end of the study, 5 2.4%of children in both groups with no medication changes were still experienci ng persistent symptoms. Conclusions: School-based asthma screening identified m any symptomatic children in need of medication modification. Provider notificati on, however, did not improve preventive care. Findings suggest that more powerfu l interventions are needed to make systematic asthma screening effective. Background: Guidelines for the prevention of medications for all children with persistent asthma, yet young urban children often receive inadequate therapy. Th is may occur in part because primary care providers are unaware of the severity of their patients’symptoms. Objective: To determine whether systematic school - based asthma screening, coupled with primary care provider notification of asthm a severity, will prompt providers to take preventive medication action (prescribe a new medication or change a current d ose). Design: Children aged 3 to 7 years with mild persistent to severe persiste nt asthma were identified at the start of the 2002-2003 school year in Rocheste r. Children were assigned randomly to a provider notification group (child’s primary care provider- mes of asthma severity) or a control group (provider no t- Primary care providers of children in the provider noti fication group were sent a facsimile indicating the child’s sympto Results: Of 164 eligible children with mild persist or more severe asthma, 151 (92.1%) were enrolled. Children in the provider notification group were not more likely to receive a medication actio n than were children in the control group (21.9% vs 26.0%; P = .57). Additional p reventive measures, including encouraging compliance with medications (33.3% vs 31.3%; P = .85), recommending environmental modifications (39.3% vs 42.4%; P = .86), and referrals for specialty care (6.6% vs 6.0% At the end of the study, 5 2.4% of children in both groups with no medication changes were still experienci ng persistent symptoms. Conclusions: School-based asthma screening identified any symptomatic children in need of suggest more powerfu l interventions are needed to make systematic asthma screening effective.