Aim: To compare the effectiveness of inhaled corticosteroids (ICS) versus leukotriene receptor antagonists (LTRA) in managing pediatric asthma. Material and Methods: This prospective, comparative study included 140 children aged 5–12 years diagnosed with asthma. Participants were divided into two groups: 70 children receiving ICS (budesonide or fluticasone) and 70 receiving LTRA (montelukast). Treatment regimens followed GINA guidelines and were adjusted based on asthma control levels. Clinical parameters, including Asthma Control Test (ACT) scores, lung function (FEV₁ and FEV₁/FVC ratio), symptom frequency, rescue inhaler use, exacerbation rates, and medication adherence, were recorded at baseline, 4, 8, and 12 months. Data were analyzed using paired t-tests, repeated measures ANOVA, and chi-square tests, with p<0.05 considered statistically significant. Results: Baseline characteristics were comparable between groups (p>0.05). Over 12 months, the ICS group demonstrated significantly greater improvements in ACT scores (22.30 ± 2.30 vs. 21.20 ± 2.50, p=0.019), FEV₁ (84.10 ± 7.90% vs. 79.30 ± 8.20%, p=0.041), and peak expiratory flow. The ICS group also reported fewer exacerbations (1.30 ± 0.60/year vs. 1.80 ± 0.70/year, p=0.023) and lower rescue inhaler use (2.10 ± 1.20 days/week vs. 3.20 ± 1.50 days/week, p=0.018). Adherence was higher in the ICS group (82.9% vs. 70.0%, p=0.045), and symptom frequency (daytime and nighttime) was significantly lower compared to the LTRA group. Conclusion: ICS therapy is more effective than LTRA in improving asthma control, lung function, and reducing exacerbations in pediatric asthma. While LTRA may be suitable for specific cases, ICS should remain the first-line treatment for persistent asthma in children. Personalized management plans can further enhance outcomes.