This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Children with asthma who are exposed to cigarette smoke have higher morbidity levels than those of children not exposed. Corticosteroids, either oral or inhaled, are among the most effective medications for asthma because they decrease inflammation that underlies asthma symptoms. A recent study showed that children who were given thier inhaled steroids at school showed improvements compared to children with usual care; however, the improvement occurred only among the children not exposed to cigarette smoke at home. Among adults with asthma, cigarette smokers do not respond to oral steroids as well as non-smokers, and and studies of cells show the ways in which the cells of smokers are not responsive to steroids. In this study we will test the effectiveness of steroids among low-income children who participated in a study since they were infants and who were found at age 7 to have asthma. We hypothesize that children with asthma who area exposed to cigarette smoke will respond more poorly to a course of oral steroids than will the non-exposed children, and that their clinical responsiveness will be reflected in tests done on their blood cells. The children will come in to the laboratory where symptom reports and lung testing will be used to determine whether their asthma is being poorly controlled, thier blood will be drawn, and their exposure to cigarette smoke will be evaluated. Those whoare in poor control will receive prednisone (an oral steroid) for one week. They will return for an evaluation based on lung testing and symptom report to determine their clinical response to the prednisone. Their blood will be tested to see if the steroid response pattens identified among smoking with adults with asthma is similar among children with asthma who are exposed to secondhand tobacco smoke.
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