The prevalence of asthma has increased over the past two decades; if this trend persists over the next two decades, the number of individuals with asthma in the United States will double by 2020, affecting 29 million Americans. Many of these individuals will be adults. Recent community-based participatory research in Harlem has focused on children with asthma, but little is known about the prevalence and burden of asthma among adults. We conducted a population-based probability sample of Central Harlem adults 18-65 years of age from 1992 to 1994. Asthma was one of three ambulatory care-sensitive conditions surveyed. We used an additional set of questions regarding asthma management and burden for those respondents who reported they had asthma. The prevalence of self-reported asthma was 14% in this population-based sample of Central Harlem adults. Respondents with asthma reported remarkably high rates of emergency department (ED) visits for asthma, but women were more likely than men to report two or more ED visits in the year prior to interview (38% vs. 18%). Women with asthma were also more likely than men with asthma to report activity restrictions because of asthma (61% vs. 26%). The burden of asthma among adults in Central Harlem is considerable. We urgently need comprehensive health approaches to address the high prevalence of health risks related to multiple chronic diseases, notably smoking and obesity. Key priorities are to determine which community education, prevention, and promotion programs are most effective and will best serve Harlem adults.