This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The objectives of the National Institute of Allergy and Infectious Diseases Inner City Asthma Consortium (ICAC) are (1) to identify forms of immune-based therapy to promote control and prevention of asthma, (2) to design protocols to evaluate immune-based therapies in the treatment of asthma in low-income inner-city children, and (3) to determine mechanisms of immune-based therapies and the potential unique mechanisms of asthma pathogenesis in low-income inner-city children by the conduct of parallel mechanistic investigations with the therapeutic protocols.The National Asthma Education and Prevention Program (NAEPP) asthma guidelines will change with further understanding of the pathogenesis of asthma, the introduction of new medications including immunomodulators, such as anti-IgE, and the potential application of biomarkers and pharmacogenetics in the clinical management of asthma. One of the additional measures proposed in this study is the use of biomarkers, specifically the measurement of exhaled nitric oxide (eNO) using the Aerocrine NIOX device. eNO can easily be measured in less than 15 minutes. It is anticipated that using eNO measurements in addition to using the NAEPP guidelines will enhance the level of assessment of asthma, guide medication regimens, and improve overall asthma control. Studies support the role of eNO in the clinical treatment of asthma, as an added approach to improve asthma control. Exhaled nitric oxide could serve as a monitor of poor asthma control due to poor symptom recognition, poor medication adherence, and persistent inflammation. The study results may change the paradigm of management for children with persistent asthma, which could be particularly beneficial for inner city asthma children where there appear to be unique characteristics, such as allergen exposure and poor adherence to therapy, that result in persistent inflammation.