Severe asthma is a term that is commonly used to describe patients with refractory, brittle, near fatal, and difficult-to-control asthma. Patients with severe asthma typically experience persistent symptoms despite medical therapy, report decreased quality of life and suffer an accelerated loss of lung function. The role of genetics, environmental exposure, and infection in the development of more severe asthma is the focus of ongoing research. While pathologic changes in these patients are now believed to involve lung parenchyma, in addition to large and small airways, the independent contribution of each of these compartments to the severe asthma phenotype is not well defined. The clinical evaluation of severe asthma patients should include investigating conditions commonly associated with severe asthma, such as gastroesophageal reflux disease, vocal cord dysfunction, and rhinosinusitis. In addition, advanced imaging techniques, measurement of exhaled gas or sputum indices, and airway biopsy are tools that may aid in evaluating severe asthma patients in the near future. Management of patients with severe asthma requires a comprehensive approach that includes non-pharmacological and pharmacological measures. Combination antiinflammatory and long-acting bronchodilator therapy remains the mainstay of management.