Asthma remains a major cause of morbidity in the Australian community, despite enhanced strategies and interventions for achieving optimal outcomes. Although there is some evidence of over use of high doses of inhaled corticosteroids (ICS), there is also evidence for under use of ICS, despite long-term data demonstrating clear benefits of low doses. The present paper briefly discusses some of the issues that are pertinent to the development of sensitization and atopic disease, but focuses mainly on the current understanding of best clinical practice for adults with asthma and the optimal approach to management. A clear definition of asthma control and a systematic approach to down-titration to minimize ICS doses is crucial to achieving better outcomes. Patient self-management education and optimal therapy are the keys to achieving better outcomes, although uncertainty remains about recommendations for mild asthma, despite new data.