When asthma is not asthma requires first an understanding of what asthma is, how to diagnose it, and what to expect when its treated. Asthma is an exceedingly common disorder manifested by varying degrees of cough, wheeze, and dyspnea. Familiarity with asthma, in contrast to lack of familiarity with the less common disorders described in this review, has resulted in patients with cough, wheeze, and or dyspnea inappropriately being treated for asthma without clinical benefit. Cough, wheeze, and dyspnea can be a result of various anatomical and functional disorders that have all too often been misdiagnosed as asthma. An increased awareness, a careful history, and assessment of response to therapy can generally distinguish symptoms that are not from asthma from actual asthma.