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Few strategies to improve adherence in asthma have been subjected to adequate trial. Such strategies have been summarized by Milgram and Bender as educate, communicate, negotiate treatment goals, streamline, remove barriers and individualize. Education alone is insufficient to ensure high levels of adherence, and such initiatives have been shown to have limited influence on patient behaviour. From other chronic conditions, it is known that the doctor-patient relationship is critical; strategies, such as a nonjudgemen-tal environment (in which a degree of nonadherence is assumed), an empathetic and nonpunitive approach, the use of open-ended statements and the establishment of a partnership with shared responsibilities using clear language to explain recommendations, help to reduce nonadherence.