 Children will be treated based on normal practice patterns for our ED and the decision to discharge a patient will be at the attending physicians discretion. All children will receive 2 mgkg of methylprednisolone up to a maximum dose of 60 mg orally within the first 60 minutes of treatment or 0.6mgkg of oral dexamethasone max 15mg given in the Emergency room. When discharged home all children will be given a prescription for 4 days of methylprednisolone in a dose of 1 mgkg given once daily Patients will be assigned in a double blind fashion to budesonide nebules or placebo. A computer generated table of random numbers will be used to assign children to treatment group. Groups will be randomized in blocks of 10. A locked area in the ED will contain numbered plastic bags each containing either budesonide nebules or identical appearing and tasting placebo nebules. Study personnel and patients will be blinded to treatment allocation for the entire length of the trial. Patients will be given instructions on the use and dosage based on weight of the study medications. 