The School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) program is designed to improve guideline-based preventive asthma care among children ages 3-10 attending Rochester city schools. The program builds on the School-Based Asthma Therapy (SBAT) trial and the School-Based Preventive Asthma Care Technology (SB-PACT) study with a new focus on sustainability and dissemination. The SB-TEAM program utilizes a novel, web-based communication system, school-based directly observed therapy of preventive medications, and ongoing monitoring and tailoring of therapy using telemedicine to facilitate guideline-based asthma care for children. This program is designed to be fully integrated within school systems, health systems and community organizations that serve high risk children, with the goal of creating an effective and replicable system of preventive asthma care to be disseminated to other communities.