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): 6.0-18.0,  Asthma Able to perform reproducible spirometry according to American Thoracic Society (ATS) History of asthma symptoms (e.g., cough, wheezing, shortness of breath) and meets at least one of the following 1. Naïve to controller therapy and meeting National Asthma Education and Prevention Program (NAEPP) for mild-moderate persistent asthma (symptoms at least 2 days per week and/or night-time awakenings due to asthma at least 2 nights per month) 2. Current uncontrolled asthma (meets NAEPP for mild-moderate persistent asthma) while receiving an ICS dose greater than or equal to 200 ug per day of fluticasone equivalent or some form of non-ICS controller therapy (e.g., montelukast, theophylline, cromolyn) 3. Asthma is currently under control while receiving an ICS dose between 300 to 400 ug per day of fluticasone equivalent and willing to consider changing current treatment to monotherapy with one dose of ICS (current standard of care) 4. Asthma is currently under control while receiving some form of combination therapy, such as ICS less than or equal to 200 ug per day of fluticasone equivalent in addition to a non-ICS controller therapy (e.g., LABA, montelukast, theophylline, cromolyn), and willing to consider changing current treatment to monotherapy with one dose of ICS (current standard of care) FEV1 reversibility of at least 12% following bronchodilator administration (4 puffs) at study visit 1. Individuals will need to hold albuterol, montelukast, theophylline, ipratropium bromide (or other anticholinergics) and LABAs per study instructions prior to reversibility testing. If an individual is receiving these types of medications prior to study visit 1, he/she may be brought back to the clinical center within 1 week following appropriate medication withholding to attempt qualification by reversibility criteria. If the individual does not meet this requirement, they may qualify for enrollment if their PC20 methacholine FEV1 is less than or equal to 12.5 mg/ml at the time of randomization. If FEV1 is less than 70%, thus precluding the methacholine challenge at this visit, then completion of the visit will be postponed several days and an additional attempt to obtain a methacholine challenge test will be made. If the methacholine challenge still cannot be performed, an individual may still qualify by reversibility at this visit History of clinical varicella or varicella vaccine; individuals needing the vaccine may receive it from their primary care physician prior to study entry Ability of parent to provide informed consent; verbal assent must be obtained from children less than 7 years of age and written assent must be obtained from children between 7 and 18 years of age If female, willing to use an effective form of contraception Prior to being randomly assigned to a treatment group, participants must meet the following to remain in the study Lack of acceptable asthma control during the 8-week screening period as defined by the following 1) On average, on more than 2 days per week, one or all of the following: 1. Diary-reported symptoms 2. The use of inhaled bronchodilator (not including pre-exercise) 3. Peak flows in the yellow zone (less than 80% of post bronchodilator PEF value obtained at study visit 1) OR On average, more than 1 night-time awakening due to asthma, during each 2-week period  Corticosteroid treatment for any condition prior to study entry within the following defined timepoints: 1. Oral Use within 2 weeks of the screening visit 2. Injectable Use within 2 weeks of the screening visit 3. Nasal May be used at any time during the study at the discretion of the study investigator or primary care physician Current or prior use of medications known to significantly interact with corticosteroid disposition (within a 2-week period of study visit 1), including but not limited to carbamazepine, erythromycin or other macrolide antibiotics, phenobarbital, phenytoin, rifampin, or ketoconazole Pre-bronchodilator FEV1 less than 60% predicted at study visit 1 More than three hospitalizations for asthma in the year prior to study entry 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 or would place the participant at increased risk while participating in the study History of cataracts, glaucoma, or any other medical disorder associated with an adverse effect to corticosteroids