Inhaled corticosteroids are the first-line treatment in persistent childhood asthma, especially in moderate and severe stage. Some of recent asthma guidelines accept possibility of leukotriene receptor antagonist (LTRA) use as a monotherapy. The choice of controller therapy depends on many parameters. The most important are: child’s age, the clinical phenotype, degree of asthma control, safety of the treatment and possibility of patient and family compliance. The effective asthma management depends on treatment individualization following individual assessment of asthma progression risk. The clinical parameters for LTRA use as the first-line treatment in childhood asthma were described.