What is the initial drug of choice for a moderate persistent asthmatic in the 12-year-old and above category?

For a 12-year-old and above with moderate persistent asthma, the recommended initial drug of choice is a medium dose inhaled corticosteroid (ICS). This approach is aligned with current clinical guidelines, which suggest that when a patient demonstrates symptoms that are present more than twice weekly but not daily, and experience nighttime awakenings that occur more than once a month, a medium dose ICS is effective.

Inhaled corticosteroids work by reducing inflammation in the airways, improving lung function, and decreasing the frequency and severity of asthma attacks. This step helps to achieve better control of asthma symptoms while minimizing potential side effects that can come from more intensive treatments.

While options like high dose ICS and long-acting beta agonists (LABA) might be considered in the future if control is not achieved with medium-dose ICS, starting with a moderate approach is typically preferred. Low dose ICS may not provide sufficient control for moderate persistent asthma, and oral corticosteroids are usually reserved for severe cases or acute exacerbations rather than for initial treatment.