Asthma is a common chronic disease characterized by episodic or persistent respiratory symptoms and airflow limitation. A minority of patients with asthma have uncontrolled or partially controlled asthma despite intensive treatment. These patients present a special challenge because of the extensive diagnostic evaluation that they need, insufficient evidence regarding personalized treatments, and their high consumption of health-care resources. Asthma treatment is based on a stepwise and control-based approach that involves an iterative cycle of the assessment, adjustment of the treatment and review of the response aimed to minimize the symptom burden and risk of exacerbations. Anti-inflammatory treatment is the mainstay of asthma management. In this review we will discuss the rationale and barriers to the treatment of asthma that may result in poor outcomes. The benefits of currently available treatments and the possible strategies to overcome the barriers that limit the achievement of control of asthma in the real-life conditions.