BACKGROUND: Nonadherence to asthma treatment has been related to increased hospital and emergency care, morbidity, and unnecessary costs. Improving patient adherence is a key component to achieving optimal outcomes. OBJECTIVE: Review barriers, interventions, and communication skills shown to be effective in promoting asthma adherence. METHODS: Asthma adherence literature was reviewed. RESULTS: Sequential management principles to achieve adherence include the following: (1) measuring adherence, (2) identifying barriers that result in nonadherence, (3) using specific strategies to overcome barriers; and (4) using communication skills to enhance the delivery of selected strategies. CONCLUSION: Careful attention to adherence management principles may increase adherence, enhance outcomes, and reduce unnecessary morbidity and cost. The case described applies these principles and gives the reader a framework to review. (C) 2013 American Academy of Allergy, Asthma & Immunology