In recent years, through the promotion of standardized diagnosis and treatment of asthma, the overall level of asthma control has been improved to some extent, but there are still a small number of patients whose asthma does not reach a well-controlled state even with high doses of controlled drugs including combination therapy, and this group of patients is currently referred to as refractory asthma. It is estimated that refractory asthma accounts for about 5% of asthma patients, but it causes a huge social and economic burden. Improving the diagnosis and treatment of refractory asthma is of great importance to improve the overall control of asthma and improve the prognosis of the disease and reduce the cost of medical care. There are multiple factors that contribute to difficult asthma control, and clinicians should help patients identify and carefully screen for them, such as gastroesophageal reflux disease. I. Fully understand the clinical features of refractory asthma The clinical features of refractory asthma were described by the American Thoracic Society (ATS) in 2000. Primary features: (1) persistent or near-continuous (more than half of the year) oral hormone therapy; (2) the need for high-dose inhaled hormone therapy. Secondary characteristics: (1) need for daily addition of long-acting beta2 agonists or theophylline/leukotriene modulators in addition to inhaled hormones as a controller; (2) need for daily or near-daily symptom relief with short-acting beta2 agonists; (3) persistent airflow limitation (FEV1 < 80% of predicted value, pef daily variability > 20%); (4) 1 or more emergency room visits per year; (5) 3 or (5) 3 or more courses of oral hormone therapy per year; (6) exacerbation with a 25% reduction in oral or inhaled hormone dose; (7) previous fatal asthma events. The diagnosis is made by meeting one or two of the main features and two of the secondary features. However, it is also emphasized that exacerbation triggers should be excluded and the patient’s compliance with treatment should be ensured. The European Respiratory Society (ERS) also described refractory asthma in 1999 and emphasized that all patients with refractory asthma should be diagnosed only if they have been treated by a respiratory physician for at least 6 months according to asthma guidelines, with the exception of exacerbation triggers and other diseases, and with the assurance of compliance with treatment. 2014 edition of the Global Asthma The 2014 edition of the Global Asthma Initiative (GINA) considers patients with asthma who do not achieve optimal control with two or more controller medications as refractory asthma on a Tier 4 regimen. However, it also emphasizes that the diagnosis should be made on the basis of adherence to medication, excluding exacerbation triggers and other conditions. The above definitions and diagnostic criteria are basically similar, but in general, the criteria of ATS are more refined and easy to grasp and use clinically; ERS emphasizes more on assessment, follow-up and differential diagnosis, while the 2006 version of GINA emphasizes more on asthma control. Only by fully understanding and grasping the basic features of refractory asthma can we lay the foundation for conducting further examination, evaluation and determining the diagnosis. Our consensus combines the above opinions to define refractory asthma as asthma that is not well controlled after at least 3-6 months of standardized treatment with two or more control medications including inhaled hormones and long-acting β2 agonists. II. understand and master the diagnostic and evaluation procedures of refractory asthma Recognizing refractory asthma should be approached from the following three aspects. (1) medication aspects; (2) exacerbation triggers; and (3) associated diseases, co-morbidities or symptom-like diseases. The pharmacological aspects include three main aspects: (1) adequacy of treatment; (2) compliance with treatment; and (3) mastery of inhalation techniques and treatment protocols. Compliance with guidelines for standardized treatment and education and management of asthma are important to improve the level of asthma control. The China Asthma Alliance has launched a nationwide project to promote “asthma-specific outpatient clinics and education and management” to serve as a better model. Based on overseas guidelines and the practical experience of our colleagues in China, our consensus suggests that the diagnosis and evaluation of patients with refractory asthma should follow the following basic procedures: (1) determine the presence and severity of reversible airflow limitation; (2) determine the adequacy of medication, medication compliance and mastery of inhalation techniques; (3) determine the presence of unremoved risk factors for exacerbation of asthma; (4) compare the diagnosis with that of patients with cough, dyspnea, and asthma. (4) Differential diagnosis with diseases with symptoms such as cough, dyspnea and wheezing; (5) Conducting relevant tests to determine the presence of associated or aggravating co-morbidities; (6) Repeatedly assessing the patient’s level of control and response to treatment. And for the convenience of clinicians to grasp clearly, this consensus also depicts the flow chart of clinical diagnosis and management of refractory asthma. The above procedures reflect the clinical thought process of diagnosis and assessment of refractory asthma, and are important references for improving the diagnosis and differential diagnosis. Third, one should be good at screening and dealing with factors that lead to uncontrollable asthma The factors that lead to uncontrollable asthma are various, and clinicians should help patients to find and carefully screen them. In addition to prescribing medications, clinicians should learn to take a detailed medical history including occupational history, living environment, medication use and lifestyle habits. Such as indoor and outdoor environments (allergens or irritants), medications, smoking, infections, occupational exposures, etc. Associated diseases or comorbidities such as allergic rhinitis, sinusitis, gastroesophageal reflux, obesity, obstructive sleep apnea hypoventilation syndrome (OSAHS), psychological factors, and recurrent respiratory infections can all contribute to poor asthma control, and only adequate treatment of these conditions can effectively control asthma; therefore, adequate investigations should be performed to help identify them. Smoking is not only a trigger for asthma, but also an important cause of refractory asthma. A 2007 survey organized by the Chinese Asthma Alliance showed that nearly 10% of current asthma patients were current smokers. It is especially important to discourage asthma patients from smoking and to help them quit smoking. Fourth, set up a national collaborative group for the prevention and treatment of refractory asthma to strengthen the prevention and treatment research Form a nationwide surveillance network through the collaborative group, register patients with refractory asthma, systematically follow up and track patients with refractory asthma, and understand the natural history of refractory asthma. It is of great value in gaining a deeper understanding of whether refractory asthma is one disease or many different diseases. To establish a national database on the clinical, pathological and pathophysiological characteristics of patients with this disease. Longitudinal studies, particularly in children, may help to identify different types of refractory asthma in children and adults. The establishment of a repository of specimens that can be used for further studies of immunological, pathological and genetic characteristics provides the basis for higher level studies in the future. The establishment of this network provides a fundamental guarantee for strengthening cooperation and communication with relevant organizations in the Asia-Pacific region and the world. We should pay attention to epidemiological studies of refractory asthma, which can be combined with the current national epidemiological survey on the prevalence and risk factors of asthma (CARE) to determine the prevalence of refractory asthma, the risk factors for its development, the proportion of various subtypes, and the disease burden caused, in order to provide baseline data for future prevention and treatment efforts. Other aspects that need to be studied include genetic studies, such as the role of hereditary factors in the development of the disease, and pharmacogenetic studies. An important feature of refractory asthma is reduced hormone responsiveness, and research on glucocorticoid responsiveness should focus on what factors determine glucocorticoid responsiveness in severe asthma? What factors can reverse glucocorticoid responsiveness? There are different inflammatory and clinical phenotypes in refractory asthma, and the study of the mechanisms underlying the different phenotypes and the optimization and promotion of treatment regimens for the different phenotypes is an important task. Similar to the clinical types, there may be multiple pathological processes associated with the development of refractory asthma. The study of the association between persistent airway inflammation and irreversible airflow limitation and with airway remodeling as well as the exploration and development of noninvasive, accurate and reliable evaluation methods are also important future research. Accelerate the introduction and development of new therapeutic drugs and methods. In particular, anti-IgE monoclonal antibodies, which have been well studied abroad, can significantly improve asthma symptoms, reduce oral hormone dosage, and reduce acute asthma exacerbation and hospitalization rates in patients with severe asthma who have significantly increased serum IgE levels after treatment. Since 2006, GINA guidelines have recommended this product as one of the important drugs for the treatment of refractory asthma. Therefore, in collaboration and cooperation with the drug evaluation department, it is one of the very urgent tasks in the coming period to accelerate the research on the efficacy and safety of the drug. Bronchial thermoplasty (bronchialthermoplasty) has been approved by the United States, the European Union, Australia and China for the treatment of severe asthma that is not well controlled by conventional drugs. How to realize the introduction and use in China, especially how to better define the indications is also a problem to be considered in the future. In addition, how to carry out research on therapeutics with Chinese characteristics, such as strengthening the research on traditional Chinese medicine and establishing a scientific evaluation system, are also future research topics.