A 23-year-old woman is newly diagnosed with asthma. According to updated guidelines for patients aged 12 and over, what would be the most appropriate first-line treatment option?

• A. Montelukast
• B. Inhaled corticosteroids daily
• C. Budesonide/formoterol as required (AIR therapy)
• D. Short-acting beta-agonist only

Answer: (C)

The key idea is that for patients aged 12 and over, guidelines now favor starting treatment with an inhaled corticosteroid-formoterol combination used as needed. This approach provides anti-inflammatory therapy every time the inhaler is used, while also offering rapid relief of bronchospasm, so the patient gets control and symptom relief in one device. Using budesonide/formoterol as-needed helps reduce the risk of severe exacerbations compared with relying on a rescue inhaler alone, and it supports better overall asthma control by addressing both inflammation and bronchoconstriction from the outset.

Montelukast alone is a less effective option as a first-line controller for most patients. Daily inhaled corticosteroids are a valid therapy, but current guidance prioritizes as-needed ICS-formoterol as the initial approach. A short-acting beta-agonist only regimen misses the anti-inflammatory component and is not recommended as first-line.