Asthma is a chronic inflammation of the airway and has affected 300 million individuals throughout the world which causes 250000 deaths per year. Asthma occurs in all age groups and the produced drugs cannot prevent asthma but also have systemic side effects. Healthcare costs related to asthma in average are more than US$500 per emergency visit and US$2000 per hospitalization. Asthma imposes direct and indirect costs. The objective of this study is focusing on the main challenges of asthma. An observational study was designed in primary care settings in Iran in order to determinate the main challenges of surveillance system, diagnosis, control and treatment of asthma. According to our searches from ministry health database, about 6.5 million people in Iran are asthmatic and more than 3.2 billion US$ is spent on asthmatic patients in Iran. Main challenges, plans and actions for asthma are listed. The direct costs represented about 30% of the total costs and the indirect costs is hidden and is the main part of costs. The high morbidity and mortality rates of asthma should be added to these costs. Health policy should emphasis on improving asthma control which can be beneficial for the patients, their families, even though the economies of countries as reductions in the cost of asthma care and increases in productivity.