To assess asthma medication readiness among low-income, urban, preschool-aged children and examine the association of medication beliefs among caregivers.Researchers in this cross-sectional study enrolled 288 caregivers of low-income children, predominantly African American (91.7%), ages 2 to 6 years with physician-diagnosed asthma of varying severity. Eligible caregivers had to be a parent or legal guardian and speak English.Caregivers of preschool-aged children were recruited from Baltimore City Head Start Programs between April 2011 and November 2016. During a 2-hour home visit, a research assistant interviewed the caregiver in the primary home of each child and visually inspected their asthma medications to assess medication readiness, using a 5-criteria index: caregiver ability to locate each reported medication (criterion 1), expiration date (criterion 2), remaining doses based on the medication counter (criterion 3), caregiver ability to properly identify medications as rescue or controller (criterion 4), and caregiver recall of dosing instructions for the medication(s) (criterion 5). Caregivers also answered questions regarding medication beliefs, adherence, and level of asthma control. Beliefs about asthma medications were assessed by using the validated 5-point Likert scale, the Pediatric Asthma Medication Beliefs Assessment (PAMBA). Higher PAMBA scores indicated more positive beliefs. Caregivers self-reported frequency of controller use, and those who indicated “almost every single day” or “every single day” were considered adherent.Among 288 participants, 96% reported use of a rescue medication, and 56% reported use of a controller medication, most commonly fluticasone metered-dose inhaler. Only 60% of those with a rescue medication met all 5 readiness criteria. Readiness was lower for those using a controller medication (49%). Caregivers were less able to state dosing instructions regarding controller medications compared with rescue medications (81% vs 92%; P < .01). They were also less likely to correctly identify controller compared with rescue medications (78% vs 94%; P < .01). One-third of children were found to have empty canisters of rescue or controller metered-dose inhaler medications. Among caregivers who reported use of a controller, 56% reported daily or nearly daily adherence. Caregivers who could locate the medication in the home were more likely to report adherence, although notably, 10% reported adherence but could not locate the controller whereabouts in the home. High self-reported adherence to controller medications significantly increased the odds of meeting all 5 readiness criteria for controller medications (adjusted odds ratio: 4.59; P < .01) as did higher PAMBA scores, indicating positive beliefs about asthma medications (crude odds ratio: 1.04; P < .05).This study found major gaps in asthma medication readiness, including availability and knowledge of medications, among caregivers of urban preschool-aged children with asthma. Positive beliefs about asthma medications were associated with better self-reported adherence and medication readiness. The authors proposed that addressing barriers to medication readiness and improving knowledge and beliefs regarding medications may improve adherence and ultimately reduce morbidity due to asthma in this high-risk population.Asthma self-management is challenging, and in the high-risk cohort living in urban environments, it can be compounded by psychosocial stressors, financial constraints, indoor exposure to allergens and irritants, multiple caregivers within the home, and low health literacy. This study highlights several potential barriers to asthma management in a high-risk population and reinforces the need for health care providers to focus on the basics at every visit. In addition to education and assessment of caregiver knowledge surrounding asthma management, it is equally important to assess adherence and assist families with identifying barriers and ways to overcome them. Lastly, this study reinforces the value identified in other studies surrounding in-home assessment by qualified health workers for children at risk for poor asthma outcomes.