Introduction Asthma is a widespread health problem and is a growing burden on our society in terms of morbidity, mortality, health care costs, and quality of life. The prevalence of asthma is raising both nationally and locally. Among asthma triggers, tobacco smoke is very powerful. Hence the main purpose of the study is to investigate the association of smoking and secondhand smoke with level of asthma control, severity, and quality of life among adult asthmatics. Asthma is a chronic inflammatory disorder of the airways characterized by episodic and reversible airflow obstruction and airway hyperresponsiveness. Clinical manifestations include wheezing, coughing, and shortness of breath (Moorman et al., 2007). Hyperresponsiveness, the exaggerated narrowing of the airways after the inhalation of various stimuli, is a key feature of asthma (Eder, Ege, & Von Mutius, 2006). Causative factors that provoke asthma include viral infections, allergy, exercise, and airborne irritants such as cigarette smoke, strong odors, dusts, and other inhaled irritants (Fireman, 2003). The exact causative mechanism of asthma is unknown, but it is believed that there is a combination of both environmental and genetic factors during the development of an individual’s immune system that leads to susceptibility of asthma. Asthma can develop during childhood, or as an adult, and the disease is believed to have strong familial ties with complex genetic derivation. Asthma is a widespread public health problem that has increased in the past two decades in Texas and the United States (Mannino, Homa, Akinbami, Moorman, Gwynn, & Redd, 2002), and there are approximately 21 million people in the United States with the diagnosis of asthma, of which 7 million are under the age of 18 (Moorman et al., 2007). Thus, the vast majority of individuals with asthma are adults. The prevalence is higher in African-American adults, and is higher among adult women than men. Women with asthma report more symptoms and poorer quality-of-life than do men, although measures of airflow obstruction are comparable (Osborne, Vollmer, Linton, & Buist, 1998). In Texas, approximately 1,000,000 adult Texans report having asthma, and many adult Texans are not in control of their asthma symptoms. Also, health related quality of life is lower in adults with asthma compared to adults without asthma (Texas Asthma Program, 2004). In Texas, 822 people have died of asthma since 1998, and asthma is responsible for approximately 25,000 hospitalizations per year – costing Texas more than 200,000,000 dollars per year in hospital charges (Texas Asthma Program, 2004). Thus, asthma poses to be a growing burden on our society in terms of disease related morbidity, health care costs, and quality of life (Fuhlbrigge et al., 2002). Hence, disease management is in the best interest of not only asthmatics, but our society as a whole. Asthma Control, Severity & Quality of Life among Asthmatics Being that asthma is a disease of chronic nature, it cannot be cured; however, the clinical manifestations can be controlled. Control is the degree to which symptoms of asthma are minimized and the goals of therapy are met (Myers & Op’t Holt, 2008). Therefore, achieving respiratory symptom control is one of the main targets in the management of patients with asthma (Nieuwenhof et al., 2006). Costa, De Oliveira, Caetano, Santoro, & Fernandez (2008) suggests that “When uncontrolled, asthma can put severe limits on daily life and can even be fa