For the first time in Russian economic conditions clinical and economic evaluation of the appropriateness of tiotropium bromide as adjunctive therapy (in addition to the standard therapy) was carried out in patients with severe asthma. Markov model was built using direct and indirect costs, data efficiency and effectiveness; research horizon was 1 year. An additional model was comparing tiotropium bromide (plus standard therapy) and omalizumab (plus standard therapy) with standard therapy. Sensitivity analysis and the budget impact analysis were done. The modeling showed that the use of the strategy of «tiotropium plus standard therapy» increased the likelihood of patients to remain in a state of controlled asthma compared to other strategies. The strategy «tiotropium plus standard therapy» reduced the likelihood of a severe exacerbation compared with standard therapy. Thus, taking into account high frequency of hospitalization of patients with asthma in Russia that was shown in pharmacoepidemiological studies, the use of tiotropium is absolutely appropriate medical technology from the standpoint of clinical and economic analysis. The strategy of using tiotropium is the most preferred strategy in terms of the budget impact analysis when compared with the strategy of omalizumab: the use of tiotropium strategy allows to save substantial budget funds that can be further used to treat a considerable number of patients.