Objective: Each year, asthma accounts for 3 million clinic visits, 550,000 emergency room visits, 150,000 hospitalizations, and 150 deaths in children under fifteen. Literature suggests that asthmatic children exposed to tobacco smoke experience complications of greater frequency and severity than those unexposed. This study proposes to test the hypotheses that asthmatic children exposed to household tobacco smoke experience more frequent and severe exacerbations and have greater inhaler use than those unexposed. Methods: NHANES' 2003-2004 database was queried to identify a cohort of 421 asthmatic children (ages 0-17) with current diagnosis of asthma and complete demographic, examination, and questionnaire data. The cohort was analyzed based on exposure to household tobacco smoke. Logistic regression was used to examine emergency room (ER) visit, wheezing frequency, and recent inhaler use. Results: Results revealed no significantly greater frequency or severity of asthma outcomes in children exposed to tobacco smoke. Household smoke exposure was only significantly associated with inhaler use. Oddly, asthmatic children living in smoking households were highly unlikely to have used an inhaler in the past month (Odds Ratio=0.493, p=0.0406). Tobacco smoke exposure was associated with higher odds of wheezing attacks, but lower odds of ER visit (though neither was significant). Conclusion: Despite results, opportunities to improve asthma outcomes exist. In the sample, children in smoking households were more likely to be African American, female, live below the poverty level, and be exposed to other indoor pollutants that trigger asthma exacerbations. Initiatives targeted to this group may improve asthma outcomes through education on reduction/elimination of unnecessary indoor allergens. Study limitations include small sample size, potential recall bias due to self or parental-report, lack of data related to family smoking and asthma history and other exposures, and time variation in data collection.