Which of the following is the preferred initial controller medication for mild persistent asthma in adults?

Explanation

## Asthma Controller Therapy — Initial Choice **Key Point:** Low-dose inhaled corticosteroids (ICS) are the gold-standard first-line controller for all persistent asthma, including mild persistent asthma, across all age groups. ### Why ICS Are Preferred 1. **Anti-inflammatory efficacy** — directly suppress airway inflammation, the underlying pathology in asthma 2. **Safety profile** — minimal systemic absorption at low doses; local topical effect in airways 3. **Rapid onset** — symptom improvement within 2–4 weeks 4. **Evidence-based** — supported by GINA, NAEPP, and Indian Asthma Society guidelines ### Comparison of Controller Options | Agent | Role | Limitation | |-------|------|------------| | Low-dose ICS | **First-line controller** | None for mild persistent asthma | | LABA monotherapy | Never monotherapy; only in combination ICS/LABA | Risk of asthma-related death if used alone | | Leukotriene antagonist | Alternative controller (less effective than ICS) | Inferior to ICS for most patients; useful for aspirin-exacerbated asthma | | Theophylline | Rarely used; narrow therapeutic window | Toxicity risk; poor efficacy compared to modern agents | **High-Yield:** LABA monotherapy is contraindicated — always combine with ICS if LABA is used. **Clinical Pearl:** Even in mild persistent asthma, daily controller therapy is required; reliever-only therapy is inadequate and increases exacerbation risk.