Bronchial asthma is a common chronic inflammatory disorder of the airways, affecting nearly 300 million people worldwide. Asthma accounts for 1/250th of all deaths each year and causes disability in 15 million patients. Most asthma patients respond well to standard treatment regimens: asthma symptoms are relieved with inhaled short-acting beta2-agonists, and long-term inhaled cortisol hormones (ICS) control airway inflammation. However, 5% of patients with asthma do not effectively control their asthma even with high-dose ICS combined with β2-agonists, often with persistent or acute exacerbation of asthma symptoms, which is referred to as “refractory asthma”. The causes of refractory asthma are multiple, such as poor adherence to treatment, misdiagnosis, persistent exposure to triggers, psychological factors, cortisol hormone resistant or dependent asthma, and irreversible airway obstruction. Therefore, other conditions causing wheezing, dyspnea, cough and eosinophilia must first be excluded when diagnosing refractory asthma. In each case of refractory asthma, a thorough evaluation of factors that may contribute to exacerbation, such as sinus disease, gastroesophageal reflux, and medication compliance, is required. Theoretically, control of these factors can be beneficial in the management of refractory asthma, but in fact there is little literature addressing the incidence of these factors and the effectiveness of targeted interventions. A common cause of poor asthma control is failure to take standardized therapy including poor adherence, and many patients with refractory asthma improve rapidly with continued use of previous medications under the supervision of a health care provider. Poor patient adherence is a common problem today. Studies have found that approximately 50% of patients with refractory asthma have difficulty adhering to long-term oral cortisol hormone therapy. In another study of dry powder inhalation medication use, only 18% of patients used their medications as prescribed. in a recent study, Gamble et al. found that only 21% of 182 patients with refractory asthma took their medications as prescribed, 35% inhaled half or less of their medications, and 45% inhaled between 51% and 100% of their medications. Of the 51 patients who required oral prednisolone, 45%; of the patients were not adherent to their medication. Thus, a significant proportion of refractory asthma is due to non-adherence to inhaled or oral cortisol hormones. The reasons for poor adherence to cortisol hormones are more complex, and the inability of ICS to provide rapid relief of asthma symptoms in a short period of time is one of the main reasons. In addition, fear of adverse effects of cortisol hormones and discomfort from previous use are also important reasons for poor adherence. Patient adherence is difficult to assess accurately because there is no exact and valid assessment method. Adherence reported in the literature is often lower than it actually is. Common methods used to assess adherence to asthma therapy vary widely and include patient asthma logs, follow-up patient medications, biochemical testing, electronic or mechanical device monitoring, case or pharmacy notes, calculation of medication residuals, and subjective judgment by the clinician. The simplest method is the patient’s asthma log, which is inexpensive and easy to use, but its content is often not accurate enough. The truthfulness of the contents of the log depends on the doctor-patient relationship and the way questions are asked. Patients sometimes overestimate their compliance with a trusted or favorite doctor to avoid disappointing the doctor. At this point, it is necessary for the physician to use other methods to help make the right judgment. Improving patient adherence is important for asthma control because there is a statistically significant difference in the efficacy of adherence between controlled and uncontrolled patients [8], so it is necessary to include adherence testing in the assessment of asthma control. In patients with poor adherence, the reasons for the patient’s inability to adhere to the medication are asked and recorded so that interventions can be individualized to address the different reasons. The use of subjective physician evaluations and patient asthma logs to assess adherence is not entirely reliable; therefore, objective and systematic evaluation approaches are used whenever possible. Although convincing data from controlled studies are lacking, scholars believe that increased patient-specific education about asthma may improve adherence to treatment. In an early study, Irwin et al. followed patients for 8 years using a systematic evaluation form and showed that 74%; of asthma was controlled according to their protocol-guided treatment, including improvements in asthma symptoms and lung function. Studies have also shown that the most effective intervention is the standardized use of ICS. Recent studies have indicated that individualized targeted therapeutic interventions are more effective than standardized interventions. Results from a 24-week prospective, randomized controlled trial showed significantly higher adherence to ICS in the self-management intervention group than in the control group. Adherence to ICS was greater than 60% in the self-management group; a nine-fold increase over the control group at the end of the intervention. Although the control group did the same patient self-management and follow-up as the intervention group, they had little adherence to ICS, no reduction in the number of nocturnal exacerbations, no reduction in the need for inhaled β2-agonists for symptom relief, and their awareness of asthma control was even less improved. In conclusion, individualized self-management education for asthma can be effective in improving adherence to treatment, leading to better asthma control. Medication changes are another proven way to improve adherence. Since β2-agonists are effective in relieving asthma symptoms and patient compliance is relatively good, the combination of ICS + β2-agonists is a good choice. It has been demonstrated that ICS + β2-agonists have higher compliance than ICS alone. For patients who cannot adhere to oral cortisol hormones, intramuscular hormones such as tretinoin can also be administered to reduce life-threatening exacerbations of severe asthma. In summary, it is critical to clarify the mechanisms and phenotypes of refractory asthma, using the available means of controlling asthma as an entry point. Based on the existing guidelines, we can implement targeted individual interventions to improve the compliance and effectiveness of asthma treatment, and thus more effectively control asthma and reduce its mortality.