The asthma insights & reality in Japan survey was aimed to assess the current status of asthma treatment and management in Japan. We used random digit dialing to identify current asthmatics in households throughout Japan. Throughout Japan, 38,132 households were contacted. A detailed survey on asthma management was conducted among 803 of these households, 401 adults and 402 children. More than half had experienced a daytime asthma attack during the previous month. More than one third had experienced an asthma attack at night during that same period. About 70% of the adults and 60% of the children with asthma reported some limitation on activities of daily life. About 50% of adults and 80% of children had never undergone any pulmonary function testing. Only 6% of adults and 7% of children's parents were aware that "airway inflammation" was a major cause of asthma. Moreover, only 12% of adults and 5% of children were using inhaled steroids. There was an especially large gap between subjective perception of asthma control and objective findings in patients with severe asthma. Many Japanese asthmatics tended to underestimate the severity of their condition. Asthma management in Japan falls far short of goals stated in the guideline. These findings emphasize the need for increased awareness of the burden of asthma in Japan.