Patient description: A 39-year-old man came to the clinic with cough and shortness of breath that was not relieved by his inhaler. He had these symptoms for 5 days during the past 2 weeks. He doubled his oral corticosteroids in the past week. He is a chef with a history of asthma for 3 years, suffering from frequent cough, wheezing, and shortness of breath and chest tightness. The symptoms become more bothersome within 1-2 hours of starting work every day and worsen throughout the work week. His symptoms improve within 1-2 hours outside the workplace. Spirometry was performed revealing a forced expiratory volume in the first second (FEV1) of 63% of the predicted. His past medical history is significant for seasonal allergic rhinitis in the summer. He doesn't smoke or use illicit drugs. His family history is significant for asthma in his father and sister. He currently uses inhaled corticosteroid (ICS) and fluticasone 500 mcg/salmeterol 50 mcg, one puff twice daily.

Clinical trial eligibility criteria: eligible ages (years): 5.0-11.0,  Asthma Physician-diagnosed asthma At least 1 exacerbation treated with systemic (oral or injectable) corticosteroids in the past 12 months Able to perform reproducible spirometry Current treatment with step 2 controller therapy [low-dose ICS, leukotriene receptor antagonist (LTRA)] OR current treatment with step 3 controller therapy [low-dose ICS + long-acting beta agonist (LABA), low-dose ICS + LTRA, or medium dose ICS] with a childhood Asthma Control Test (c-ACT) score of >19, no more than 2 prednisone treated exacerbations in the past 6 months, prebronchodilator Forced Expiratory Volume at 1 second (FEV1) ≥ 80% predicted and willing to step down therapy OR controller naïve and qualifying for step 2 controller therapy [asthma symptoms or short acting beta agonist (SABA) use > 2 days per week or night-time awakenings due to asthma > 2 nights per month] Prebronchodilator FEV1 ≥ 60% predicted Ability and willingness to provide informed assent For females of childbearing potential: not pregnant, non-lactating, and agree to practice an adequate birth control method History of clinical varicella or varicella vaccine  Systemic (oral or injectable) corticosteroids within previous 2-week period Current or recent (previous 2-weeks) use of medications known to significantly interact with corticosteroid disposition, including but not limited to carbamazepine, erythromycin, phenobarbital, phenytoin, rifampin, and ketoconazole Presence of chronic or active lung disease other than asthma Significant medical illness other than asthma, including thyroid disease, diabetes mellitus, Cushing's disease, Addison's disease, hepatic disease, or concurrent medical problems that could require oral corticosteroids during the study A history of cataracts, glaucoma, or any other medical disorder associated with an adverse effect to corticosteroids History of a life-threatening asthma exacerbation requiring intubation, mechanical ventilation, or resulting in a hypoxic seizure More than 5 prednisone treated exacerbations in the past 12 months More than 1 hospitalizations lasting >24 hours for asthma in the past 12 months History of adverse reactions to ICS preparations or any of their ingredients Receiving hyposensitization therapy other than an established maintenance regimen (On maintenance regimen for ≥ 3 months)