Summary: Asthma control is still below 60% of asthmatic population. In this review we discussed this issue at the pathophysiology level, having in mind the new 2022 GINA guidelines. We postulated several solutions to be included in clinical reasoning and treatment in asthma patients. Specifically, we focused on bronchial hyperreactivity and airway inflammation. The major failure to obtained the asthma control through utilization of the guidelines seems to be the thinking driven mostly by clinical trials and forgetting about clinical practice and basic science approach. We also focused on inhaler aspects in asthma treatment. Taken together this paper delivers a comprehensive and simple approach to improve clinical efficacy in asthma treatment.