Background Asthma is the most prevalent chronic illness in children worldwide, contributing to significant morbidity, healthcare utilization, and economic burden. In the United States, approximately 5 million children are currently affected. This review examines the environmental context and lifestyle determinants influencing pediatric asthma globally and within the U.S., with a special emphasis upon the Inland Empire (IE) in Southern California. The IE’s unique geographic landscape and role as a major transportation hub highlights its critical role for understanding how both environmental and structural factors exacerbate asthma burden in the IE pediatric population.

Methods A narrative literature review and regional data analysis were conducted to identify environmental, socioeconomic, and healthcare accessibility factors behind pediatric asthma in the IE. PubMed, Scopus, and Google Scholar were searched for peer-reviewed articles published from 2000 to 2025. Data from the American Lung Association, CDC, and CDPH were also included. Key words included pediatric asthma, Inland Empire, air pollution, asthma disparity, emergency department utilization, hospitalizations, and socioeconomic status.

Results Asthma has disproportionately affected the IE, consisting of San Bernardino (SB) and Riverside Counties. Geographically, the IE is surrounded by mountains that entrap pollutants such as vehicle emissions and industrial waste, limiting air circulation. Approximately 4 out of the top 5 most polluted cities in North America are located in the IE. Asthma ED visit rate in SB for children 0-17 years old was 60.5% and Riverside 59.3%, while the California average was 56.7%. Hospitalization rates for 0–4-year-olds were 24.4% for SB compared to California’s 17.3%. The elevated rates among school-aged children underscore the crucial need for interventions aimed at improving air quality, enhancing asthma management, and increasing access to preventive healthcare.

Conclusion Pediatric asthma is a pressing matter of concern as it impairs the normal development of children, exerts a long-lasting impact on adolescent learning, disproportionately impacts underserved communities, and places a significant burden on the healthcare system. Here we highlight the unique determinants underlying the high prevalence of asthma in the 0–17-year-old population within the IE/SB, which includes heightened environmental risks (e.g. indoor allergens and air pollutants), socioeconomic barriers, lack of targeted public health initiatives. and unmet need for specialist-oriented care. We also emphasize the need for more research to improve the public health determinants of the IE. Future research should prioritize investigation of region-specific elements to develop tailored clinical strategies that will improve long-term outcomes for vulnerable pediatric patients in the IE.