An important management strategy in asthma is the application of a cost-effectiveness review to the selected management principles. Efficacy, in the clinical trial setting, is the first determinant of effectiveness. However, in comparing the cost- effectiveness of two or more therapeutic strategies or drugs the determinants of cost-effectiveness may require more than the simple comparison of Rand value and clinical efficacy end-points. The Rand value of a successful outcome is vital. One of the main goals of long-term asthma management is to avoid asthma-related hospital admissions. An effective asthma education programme can resolve most, if not all of the shortcomings in asthma care. In addition, adherence to guideline recommendations would result in a a decrease in unnecessary and costly (cost-ineffective) therapies. Many asthmatics in South Africa are not being treated according to local or international guideline recommendations and lastly adherence is a serious problem in asthma therapy, significantly increasing asthma management costs.