PROJECT ABSTRACT/SUMMARY: Torie Grant, MD, MHS is an Assistant Professor of Pediatrics and Medicine at Johns Hopkins University School of Medicine. Dr. Grant seeks a K23 Mentored Patient-Oriented Research Career Development Award in order to obtain the skills, knowledge, and mentored research experience that are the essential foundation for a career as an independent clinical investigator studying pediatric determinants of adult lung disease. Dr. Grant's career development plan includes the pursuit of a PhD in epidemiology at the Johns Hopkins Bloomberg School of Public Health. Her mentorship team includes established physician scientists with decades of research and mentorship experience: Dr. Robert Wood (co-primary mentor) has over 30 years of pediatric asthma research and mentoring experience; Dr. Elizabeth Matsui (co-primary mentor) has been the PI of multiple pediatric asthma studies focusing on environmental exposures; Dr. Robert Wise is an expert in pulmonary function testing and asthma clinical trialist; Dr. Corinne Keet is an expert is asthma epidemiology and environmental risks for asthma and allergic diseases; Dr. Allen Everett is an expert in biomarker discovery; and Dr. Roger Peng is an environmental biostatistician with expertise in environmental exposures and health outcomes. Current pediatric asthma therapies are effective in achieving asthma control, but have little effect on the progression of asthma into adulthood. Emerging evidence suggests that indoor allergen exposure may have deleterious effects on lung function trajectory from childhood to adulthood among allergen-sensitized children with asthma. Aim 1 of this proposal seeks to examine the long-term effects of indoor allergen exposure and sensitization on lung function growth and risk of adult obstructive lung disease. Aim 2 will examine the effects of indoor allergen exposure reduction on lung function growth. Aim 3 will explore the relationship between indoor allergen exposure reduction and hypothesis-driven biomarkers of pulmonary fibrosis and remodeling. These aims will add critical knowledge to our understanding of the role of indoor allergen exposure in lung function growth, conceptualizing allergen reduction as a disease-modifying therapy. Dr. Grant's background as an internist, pediatrician, and allergist-immunologist, with training in epidemiology and biostatistics, makes her the ideal candidate to study adult lung function outcomes in pediatric asthma.