Asthma is a chronic disease with both inflammatory and bronchoconstrictive elements and often requires multiple medications. Most asthma regimens include medications with different therapeutic modes of action and a number of different medication delivery devices. To effectively participate in their asthma management, patients need to recognize each of their medication types, understand their purpose, adhere to their treatment regimen, and be proficient in using the required delivery devices. This study evaluated patient knowledge of asthma pharmacotherapy and adherence. An interview study was undertaken in two rural locations, in Australia, to elicit participants' knowledge, use, and inhalation device technique. Of participants, 75.9% used preventer medication and the remaining 24.1% used reliever medication only. Of those using preventer medication, 82.5% could distinguish their preventer from a range of asthma medicines. Metered dose inhalers (MDIs) were used by 80% of participants; 23% used a Turbuhaler®; 24% used an Accuhaler®; and 5% used an MDI with a spacer device. The study established poor medication knowledge, suboptimal device technique, and disturbing levels of adherence with management recommendations. Asthma education strategies need to be modified to engage patients with low asthma knowledge to achieve improved patient outcomes. Further, strategies need to motivate patients to use preventer medication during times when they feel well.