National1 and international2 evidence-based guidelines brought the anticipation of improved outcomes for patients with asthma. Treating asthma as an inflammatory condition became the foundation of therapy. Algorithms for step-up care were offered, and tools to monitor asthma control were promoted. Despite the positive impact on asthma mortality, national surveys have shown that the control of this disease is not meeting expectations.3,4 The reasons for this are complex, but one likely explanation is that asthma is not a single disease but a heterogeneous condition with many phenotypic expressions. Therapy, therefore, may have to be more targeted, especially in patients who do not respond to the conventional step-up guideline-driven approach.