Although much has been written on the topic of adherence (also known as compliance) in asthma, little is known about adherence in the asthmatic athlete. There are shared reasons for poor adherence to treatment among athletes of varying ages and levels of competition. The Shared Decision-Making model is considered to be the optimal approach to enhancing adherence among all patients with chronic disease but is particularly well applied to athletes with asthma. This article discusses athlete-related, physician-related, and treatment-related barriers to adherence, as well as how to overcome these barriers to promote optimal disease management. Special considerations for the elite or professional athlete are also addressed.