Background: Despite the development and dissemination of guidelines for the diagnosis and management of asthma, a gap remains between current recommendations and actual practice. Objectives: To assess the physicians' knowledge, practice and adherence to The Global Initiative for Asthma (GINA) guidelines before and after dissemination of guidelines and to identify causes of non adherence to these guidelines. Methods: A pretest-posttest design was used to evaluate GINA guidelines dissemination intervention. The study included all chest physician categories working in all chest hospitals in Alexandria. Total sample size included sixty chest physicians. An interview questionnaire was designed to collect data related to knowledge and practices of physicians in diagnosis and management of bronchial asthma and to their agreement with GINA guidelines and barriers to implementation of the guidelines. In addition, seven different case scenarios were used to assess the ability of the respondents to classify control and management of asthma.  Results: Poor practice (70%) was more marked than poor knowledge (45%) before guidelines dissemination. After guidelines dissemination, poor practice was still high (41.7%) while poor knowledge Fell to zero. Written asthma plan was used poorly by the studied physicians before as well as after guideline dissemination (3.3% and 16.7%, respectively). The reasons for non adherence of chest physicians to asthma guidelines were namely; lack of agreement with specific guidelines (26%); external barriers including lack of time, equipment or clinical space, educational materials staff support and reimbursement for services (25.6%) and poor patients' adherence to asthma guidelines (16.4%). Conclusion and Recommendations:  Even though, Alexandria chest physicians, had improvement in their level of knowledge after GINA guidelines dissemination yet, their practice and adherence to asthma guidelines was still low. To overcome barriers of physicians' non adherence, educational programs and strategies are needed to ensure actual dissemination and implementation of the guidelines.