A patient with mild persistent asthma requires daily controller therapy. What is the recommended first-line controller?

• A. Inhaled corticosteroids (low-dose ICS)
• B. Leukotriene receptor antagonists
• C. Long-acting beta-agonist monotherapy
• D. Systemic steroids

Answer: (A)

Managing mild persistent asthma focuses on reducing chronic airway inflammation to prevent symptoms and flare-ups. The best first-line controller therapy for most patients is daily low-dose inhaled corticosteroids. These inhaled steroids deliver anti-inflammatory effects directly to the airways, decreasing inflammatory cells and mediators, which lowers airway hyperresponsiveness and frequency of symptoms and nighttime awakenings. At low doses, systemic side effects are minimal, making them the most effective and safe long-term controller for mild persistent asthma.

Leukotriene receptor antagonists can help some patients, especially if inhalers aren’t suitable or adherence is an issue, but they are generally less effective as a first-line controller compared with low-dose inhaled corticosteroids. Long-acting beta-agonist monotherapy is not appropriate for asthma because it does not address the underlying inflammation and carries safety concerns; if a LABA is added, it must be combined with an inhaled corticosteroid. Systemic steroids are reserved for severe disease or acute exacerbations due to significant systemic risks and are not used as daily maintenance therapy.