ABSTRACT. Objective. Smoking among people who have asthma may be a serious health problem. We studied the prevalence of smoking and the relations between smoking and asthma, symptoms, medicine, and gender differences among adolescents with asthma.Methods. A national cross-sectional study on health and lifestyles was performed in 1996 -1997 using a computerized questionnaire in upper secondary schools in Denmark. We included 1887 pupils with asthma (defined as self-reported asthma diagnosed by a physician) and 20 688 controls. Smoking was categorized as daily, occasional, ex-smokers, and never smoked. We adjusted for age, gender, parents' job and smoking, family type, body mass index, and exercise habits.Results. In total, 37.7% smoked currently and 16.5% smoked daily; more girls than boys smoked. More pupils with asthma than without smoked daily (adjusted odds ratio [OR]: 1.15; 95% confidence interval [CI]: 1.04 -1.33), they smoked significantly more cigarettes daily (10.3 vs 9.6), and more were heavy smokers (>15 cigarettes daily; adjusted OR: 1.47; 95% CI:1.14 -1.91). Furthermore, nearly twice as many pupils who had asthma with symptoms but were not using medicine smoked as pupils who had asthma without symptoms and were using medicine (adjusted OR: 1.84; 95% CI: 0.99 -3.41). More boys with asthma than without started smoking before 14 years of age (adjusted OR: 1.75; 95% CI: 1.09 -2.81). However, more pupils with asthma had tried to quit (adjusted OR: 1.26; 95% CI: 0.99 -1.60). Pupils with and without asthma were occasional smokers and ex-smokers at a similar prevalence.Conclusions. More pupils with asthma than without smoked daily, and they also smoked more cigarettes per day. This is a major health concern, as adolescents have a high smoking prevalence in Denmark. Pediatrics 2003;111:e562-e568. URL: http://www.pediatrics.org/cgi/ content/full/111/5/e562; asthma, adolescents, smoking prevalence, smoking pattern.ABBREVIATIONS. OR, odds ratio; CI, confidence interval. S moking is a health risk, a pattern of behavior usually acquired during adolescence. In Western countries, 13% to 35% of adolescents smoke. 1 Although most of the effects of smoking are long term, smoking also has immediate effects on people with asthma. Smoking among people with asthma increases coughing and the inflammation of airways, 2 and smoking is associated with asthmatic symptoms. [3][4][5] Furthermore, physicians generally advise people with asthma not to smoke. Adolescents with asthma would therefore be expected to smoke less than adolescents without asthma. Nevertheless, the literature indicates that the smoking prevalence of adolescents with asthma is higher than 6 -8 or similar to 9,10 that of adolescents without asthma. Only 1 study found that adolescents with asthma smoke less than those without asthma. 11 More girls with asthma seem to smoke 8,12 and to smoke more cigarettes than girls without asthma, 12 and adolescents with asthma start smoking at a younger age than those without asthma. 7 However, these studies suffer from met...