We do not have the scientific information about how to treat children with asthma who are not well controlled on low-dose ICS therapy. It used to be recommended that when low-dose ICS were not effective their dose should be doubled. Studies in children, however, have investigated this statement and the results are not impressive7 . There is no scientific evidence that when control is poor in children with asthma, the dose of the inhaled steroid should be increased. We have therefore decided not to introduce into this study a treatment limb with a higher ICS dosage. There is anecdotal information, however, from many studies undertaken within the pharmaceutical industry that when children enter a study which is controlled and double-blind in nature, up to 30% of them improve, their symptoms reduce and their lung function increases8. It is therefore surprising that approximately one third of children receiving ICS are prescribed high-dose inhaled steroid therapy (≥ 800micrograms and unlicensed beclometasone dipropionate or equivalent) or they are commenced on "add-on‟ therapies such as long-acting beta2 agonists (LABA) or leukotriene receptor antagonists (LTRA) in addition to low-dose ICS. Concerns about the safety of high-dose ICS have been raised in relation to growth impairment9, hypoglycaemia10 and suppression of the adrenal cortex11 resulting in warnings on prescribing from the Medicines & Healthcare Products Regulatory Agency (MHRA) in the UK12 and from the Food and Drug Administration (FDA) in the USA. It is therefore unacceptable that approximately one third of children with asthma are being treated with the above regimes. Asthma is a very common condition and the worth of these regimes has not been proven by appropriately devised paediatric studies. The National Guidelines have been developed in a "stepwise‟ manner, the amount of medication increasing at each step if symptoms are not controlled.