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Asthma is a global burden, affecting 5% of the general adult population, of whom approximately 5–10% suffer from severe asthma. Severe asthma is a complex heterogeneous disease entity, with high morbidity and mortality. Increasingly novel techniques in computed tomography (CT) are being used to understand the pathophysiology of severe asthma. The utility and clinical implications of these CT techniques are the focus of this review.Novel qualitative and quantitative CT imaging techniques have enabled us to study the large airway architecture in detail, assess the small airway structure, and perform functional analysis of regional ventilation.Despite advances in CT imaging techniques, there is an urgent need for both proof-of-concept studies and large cross-sectional and longitudinal clinical trials in severe asthma to validate and clinically correlate imaging derived measures. This will extend our current understanding of the pathophysiology of severe asthma, and unravel the structure–function relationship, with the potential to discover novel severe asthma phenotypes and predict mortality, morbidity, and response to existing and novel pharmacological and nonpharmacological therapies.