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The conclusions drawn from this review indicate that education in asthma self-management which involves, the provision of information, self-monitoring by either peak expiratory flow or symptoms, regular medical review coupled with a written asthma action BML-190 plan improves health outcomes for adults with asthma.11 Whilst patients with severe asthma often have long-standing disease, self-management skills and knowledge in this population remains a problem13 and optimization of these skills is necessary regardless of the duration of asthma. A WAP is a set of written instructions that helps people with asthma detect early signs and symptoms of an exacerbation and provides instructions about how to manage these exacerbations. The plan Doxorubicin should include instructions for maintenance therapy, early exacerbation management and crisis management.20,21 WAP are essential to effective self-management in asthma,11 and their prescription is a key recommendation of international clinical practice guidelines for asthma.19,22 Regular review and update of WAP in patients with severe asthma can be achieved in the severe asthma clinic. Adherence is poor in many diseases, including asthma,23 and it is essential that adherence is assessed to determine whether this is contributing to poor disease control in severe asthma. Studies in severe asthma that use objective measures of adherence observe that one in three patients who were referred for assessment of their severe asthma had filled DAPT mouse therapy and 88% admitted poor adherence to regular pharmacotherapy.24 Methods to assess non-adherence in severe asthma require non-judgemental interviewing techniques and assessment of the reasons for the missed doses, such as intentional non-adherence, unintentional dose loss or a combination of both. There is also a need to develop better methods to objectively assess adherence and to design effective interventions for non-adherence in severe asthma. There are several comorbid conditions that require assessment in patients with severe asthma. Some of these conditions are relevant because they can lead to symptom misattribution or impaired quality of life. These include: VCD, COPD, bronchiectasis, OSA, rhinosinusitis, obesity, gastro-oesophageal reflux disease (GORD), anxiety and depression. Others are relevant as a complication of severe asthma, such as allergic bronchopulmonary aspergillosis, COPD, anxiety and depression. Others may develop as a consequence of therapy for severe asthma, such as osteoporosis, obesity and diabetes mellitus. It is also important to identify and assess relevant trigger factors in patients with severe asthma. Triggers include allergen exposure, occupational chemical exposure, tobacco smoking and frequent infections.