Asthma, the commonest chronic lung disease in childhood, is managed effectively with inhaled medications in most of the cases. But a subset of pediatric asthma patients continues to experience substantial morbidity even after higher doses of medications; they are referred to as problematic severe asthma. In many such cases, the apparent resistance to therapy is actually due to a number of remediable factors. These cases are called ‘difficult to treat asthma’. The physician dealing with a child with problematic severe asthma needs to follow a systematic step- wise approach to find any possible underlying causes of poor response to therapy. The evaluation starts with revisiting the diagnosis of asthma and goes through a checking the prescription, patient compliance, assessment for co-morbidities, environmental triggers and psychological factors. Only in a very small number of cases where no such remediable factors are identified, a diagnosis of severe therapy-resistant asthma is made and the child should be referred to a pediatric pulmonologist for further evaluation and therapy. Keywords: Severe therapy-resistant asthma; problematic severe asthma, metered dose inhaler, allergic rhinitis