National guidelines define asthma control as the prevention of asthma symptoms rather than the treatment of asthma exacerbations. We hypothesized that we would find a discrepancy between what parents consider adequate control compared to what health care professionals mean by "control." Data from a telephone survey conducted for the local asthma coalition served to establish a baseline measurement of community-level control of asthma among children. The sample consisted of 352 parents from the Rochester City School District, NY. Data analyses included chi-square, relative risk, and reliability statistics (kappa) to examine associations between reported asthma symptoms and parental perception of asthma control. Ninety percentage of respondents indicated that the child was well or completely controlled even though over 50% of the children had missed school, experienced asthma symptoms, made an unscheduled office visit, or used an inhaler for symptom relief. Over 40% of those reporting good control still used a rescue inhaler for symptom relief, experienced symptoms, and missed school. Forty-two percentage of children had parents whose report of symptoms was discrepant with their assessment of control. These children were at a higher risk of poor control compared to families whose responses were consistent. Parents of children with asthma thought their children's asthma was under good control despite high asthma-related morbidity. This discrepancy suggests a communication gap between health care providers and families that may contribute to underutilization of effective asthma treatments. These results have been used to focus our community interventions on increasing public awareness of the possibility of living symptom free with asthma and on increasing effective communication between families and physicians regarding the meaning of adequate asthma control.