This report highlights findings from a qualitative study about asthma care for low-income African American and Latino children ages 4-14 in Washington, DC, where nearly one in five children under age 18 has the condition. We interviewed medical providers, health administrators, policy makers and caregivers whose children had visited the IMPACT DC clinic (located in the emergency department of Childrens National Health System) about the primary barriers, challenges, and opportunities for improving asthma treatment in DC. The stakeholders each felt their school, clinic, agency, or department had a role to play in improving asthma care, and that many challenges were system-related. Three major areas where caregivers and stakeholders described system breakdowns were poor communication among caregivers, providers, and other stakeholders; inadequate access to both the quality and quantity of care needed to manage a child's asthma; and scarce long-term support to address both the social-emotional and financial burdens created by managing a chronic childhood illness.