Aim: This study aimed to compare the efficacy and safety of inhaled corticosteroids (ICS) versus leukotriene receptor antagonists (LTRA) in managing pediatric asthma, with a focus on symptom control, lung function, and asthma exacerbation frequency in children aged 6 to 16 years. Materials and Methods: This was a randomized, double-blind, multicenter study involving 100 pediatric patients diagnosed with moderate persistent asthma. Patients were randomly assigned to receive either ICS (fluticasone propionate) or LTRA (montelukast) for 12 weeks. Primary outcomes included asthma control (measured using the Pediatric Asthma Control Test [ACT]), lung function (measured by FEV1 and FVC), and the frequency of asthma exacerbations. Secondary outcomes included quality of life (measured by the Pediatric Asthma Quality of Life Questionnaire [PAQLQ]) and medication adherence (measured by the Medication Adherence Report Scale [MARS]). Statistical analysis was performed using SPSS with a significance level of p < 0.05. Results: Both ICS and LTRA groups showed improvements in asthma control, lung function, and quality of life. The ICS group exhibited a significant improvement in ACT scores (+6.3 ± 2.5, p = 0.04), while the LTRA group showed a smaller improvement (+5.3 ± 2.7, p = 0.06). Lung function, as measured by FEV1 and FVC, improved significantly more in the ICS group (FEV1: +9.8 ± 5.1%, FVC: +5.9 ± 4.3%) compared to the LTRA group (FEV1: +8.4 ± 4.8%, FVC: +4.7 ± 3.9%). Exacerbation frequency and medication adherence were similar between the two groups. The ICS group demonstrated a greater improvement in quality of life (PAQLQ: +1.9 ± 1.2, p = 0.02) compared to LTRA (+1.7 ± 1.3, p = 0.06). Adverse events were mild and moderate in both groups, with no severe events reported. Conclusion: Inhaled corticosteroids (ICS) were more effective than leukotriene receptor antagonists (LTRA) in improving asthma control, lung function, and quality of life in pediatric patients with moderate asthma. Both treatments had similar safety profiles, making ICS the preferred first-line therapy for most children with asthma, with LTRA serving as a viable option for specific patient subsets, particularly those with coexisting allergic rhinitis.