A Pilot Study to Determine the Feasibility and Utility of Implementing of the Full Scale TOM Trial

Inclusion Criteria: * Gender and Age: * Males and females, ages 18- 50 Current Smoker: * Smoke at least 5 cigarettes per day for at least 5 years * Positive urine cotinine test Asthma: * Physician diagnosed asthma * Symptomatic, as evidenced by * Use of SABA two or more times per week for relief of asthma symptoms, or * One or more nocturnal awakenings per week for asthma symptoms ACRC - SC MEETING - 19 MAY 2012 SAPS │ 25 Confidential, not for attribution or citation. * Pre-BD FEV1 greater than or equal to 40% predicted * Asthma diagnosis confirmed by either * albuterol reversibility of FEV1 by 12% or more, or * 20% fall in FEV1 at 8mg or less of methacholine * If over age 45, a DLco greater than 80% predicted * Females of childbearing potential: not pregnant, not lactating and agree to practice an adequate birth control method (abstinence, combination barrier and spermicide, or hormonal) for the duration of the study. Exclusion Criteria: * Diagnosis of COPD or emphysema * Other major chronic illnesses in the opinion of the investigator that might interfere with the study: \- e.g. including but not limited to uncontrolled diabetes, uncontrolled HIV infection or other immune system disorder, hyperthyroidism, seizure disorders, renal failure, liver disease, non-skin cancer, unstable psychiatric illness. * Recent active substance abuse (in past 6 months) * Lung disease other than asthma including COPD, bronchiectasis, sarcoidosis, or other significant lung disease * Unstable cardiac disease (decompensated CHF, unstable angina, recent MI, atrial fibrillation, supraventricular or ventricular tachycardia, congenital heart disease, or severe uncontrolled hypertension). * High risk of near fatal or fatal asthma as defined by the following 1-3 * ICU admission of asthma in the past year * more than 2 hospitalizations for asthma in the previous year * more than 3 ED visits for asthma in the previous year * intubation or ICU admission for asthma in the past 2 years * use of more than 2 canisters of inhaled short-acting beta2-agonist in past month * Acute asthma exacerbation in the past 4 weeks (treatment with systemic corticosteroids)