The addition of inhaled anti-cholinergics (Ipratropium Bromide (IB)) to β2-agonists in the treatment of asthma in the ER was shown to be effective, especially in severe asthma, and is now considered a standard therapy. However, very limited data exist in comparing the addition of ICS to anti-cholinergics and β2-agonists combination in adults. In one study the use of triple therapy was superior to the combination of β2-agonist with either IB or ICS. Up to our knowledge, this issue was not previously investigated in children. Moreover, the protocols used for adults may not be practical for the use in children.