Asthma remains the most common medical condition seen in children in primary care and the most frequent cause for medical paediatric hospital admission. It affects 1 in 8 children nationwide, approximately 50% of whom are prescribed low-dose inhaled corticosteroids (ICS). When treatment with low-dose ICS fails to control asthma symptoms, the National Guidelines suggest ensuring compliance, maximising inhaler technique and giving appropriate information about the disease to children and their families. Once these measures have been established and if asthma symptoms persist, the Guidelines recommend changing the treatment (Step 3 of the National Guidelines). The evidence at this step of the Guidelines is much weaker in children than it is in adults. The reasons for this are that few studies have been undertaken in children and most that have taken place have used adult-based outcomes such as lung function measurements. This is unsatisfactory because we know that as a chronic disease entity asthma in children is much more variable than in adults and between periods of symptoms, lung function is often normal. Pharmaceutical company studies have really only been conducted as part of their requirements to obtain a license to market their product. These studies have generally been of short-term duration. They have not added to clinicians' understanding of how and where to use the medications. They have not necessarily selected a representative population due to their entry criteria and their intensive study requirements. Such requirements mean that "real-life‟ compliance does not occur. In the independent National Dutch Study which attempted to enter patients uncontrolled on low-dose ICS, three treatment groups were employed: inhaled corticosteroids alone, inhaled corticosteroids in double the dose and inhaled corticosteroids + a long-acting beta2 agonist. There was essentially no difference in outcome measures between the three treatment groups as once again the primary outcome measure was that of lung function (FEV1). Comparing this study with a similar adult study6 both of which used lung function as the primary outcome measure, the mean FEV1 on entry into the paediatric study was approximately 89% expected for the children‟s heights. In the adult study the mean FEV1 on entry into the study was 74% expected. It is therefore not surprising that the paediatric study was unable to show any differences between the treatment groups.