Asthma is a serious global health problem that affects people of all ages. The best strategy to reduce the mortality and morbidty of asthma is evidence-based management based on guidelines. National and international guidelines are available worldwide but they are not being implemented. The main barriers to implementation include difficulties in implementing a structured-care approach, advocated by guidelines in different healthcare systems, and patient noncompliance. Additional barriers in developing countries include poverty, inadequate resources and poor infrastructure. Many of these barriers are potentially correctable or ameliorable, and the goal of guideline implementation is to translate evidence-based asthma-management recommendations into real-life practice to improve patient health and reduce healthcare cost. This article reviews the challenges and current status of asthma management and highlights the new global initiatives for bringing optimal asthma care to asthma sufferers in resource-poor countries.