The main objective of asthma treatment is to control symptoms of the disease; however, despite the availability of guidelines and
many groups of medications, the degree of control of this condition is insufficient. In difficult-to-treat asthma, the optimal control
cannot be achieved due to reasons independent of the disease. Factors worsening asthma control include: inadequate treatment
plan (low therapy adherence and compliance), inappropriate inhalation technique, insufficient symptom control using the available
classes of medications, incomplete response to treatment (non-responders, steroid-resistance), incorrect diagnosis of asthma or
comorbidities, and environmental factors. In order to achieve the optimal asthma control, it is recommended to: take therapeutic
decisions with the patient, assess the probability of non-compliance, perform detailed diagnostics and initiate treatment of concomitant
diseases, carry out differential diagnosis of conditions mimicking asthma, educate the patient as to the inhalation technique
and check it, eliminate unfavourable environmental factors, and modify current treatment. New treatment options for patients with
asthma include: ultra-long-acting beta2-agonists, long-acting muscarine receptor antagonists (LAMA), monoclonal antibodies,
and non-pharmacological interventions. The only LAMA approved for treatment of asthma is tiotropium bromide. The analyses
performed demonstrated a high efficacy of tiotropium in terms of improved lung function parameters and prolonged time to the
first asthma exacerbation. It is recommended as an add-on therapy at asthma treatment steps 4 and 5 according to GINA (Global
Initiative for Asthma) 2014. The optimal asthma control is important from the medical as well as the economical point of view.