Despite the obvious progress in therapy, severe and non-controlled bronchial asthma forms still constitute a significant proportion of the number of patients with asthma. The need for new approaches to treatment led to a review of the anticholinergic drugs role in the asthma treatment. The publication presents a scientific overview of the asthma management evolution, a modern understanding of the anticholinergic drugs role and place in the asthma therapy in accordance with the changed paradigm of the basic therapy as well as the results of the own real-life research on the tiotropium appliance for treating severe asthma. Administration of the tiotropium bromide solution in an inhaler together with inhaled corticosteroids and long-acting beta-2 agonists is safe, effective, and economically justified for the uncontrolled severe asthma basic therapy. The own data obtained in the real clinical practice confirm the high efficacy of tiotropium in bronchial asthma treatment beyond the limitations of a randomized clinical trial. The rapid positive dynamics of ACQ, a decreased the number of the short-acting beta-2 agonists daily doses and the FEV1 increase demonstrate a pronounced tiotropium broncholytic effect in patients with severe asthma; the positive dynamics maintenance throughout the observation period and the slow negative dynamics after the tiotropium administration discontinuation confirm the non-broncholytic drug effects presence.