OBJECTIVE： To observe clinical efficacy and safety of tiotropium bromide combined with budesonide formoterol in the treatment of severe bronchial asthma in adults. METHODS： A total of 110 adult patients with severe bronchial asthma were selected from our hospital during Mar. 2013-Mar. 2016 were divided into control group and observation group according to random number table， with 55 cases in each group. Control group was given Budesonide formoterol powder for inhalation， 2 inhalations each time， bid； observation group was additionally given Tiotropium bromide powder for inhalation 18 μg，qd， on the basis of control group. Both groups were treated for 6 months. Clinical efficacies as well as ACT scores， respiration function indexes and the times of acute attack of asthma before and after treatment， the occurrence of ADR were compared between 2 groups. RESULTS： The efficiency rate and total response rate of observation group were 54.55％ and 96.36％， which were significantly higher than 32.73％， 78.18％ in control group， with statistical significance （P＜0.05）. Before treatment， there was no statistical significance in ACT scores， respiration function indexes or the times of acute attack of asthma between 2 groups （P＞0.05）. After treatment， ACT scores of 2 groups were significantly higher than before treatment； FEV1， FEV1/FVC and PEF were significantly greater than before treatment， PEFR was significantly lower than before treatment； and the indexes in observation group was significantly better than control group， with statistical significance （P＜0.05）. 1， 3， 6 months after treatment， the times of acute attack of asthma in 2 groups were significantly less than before treatment， and that in observation group was significantly less than control group， with statistical significance （P＜0.05）. The incidence of ADR in observation group was 20.00％， and there was no statistical significance compared to 14.55％ of control group（P＞0.05）. CONCLUSIONS： Tiotropium bromide combined with budesonide formoterol in the treatment of severe bronchial asthma in adults can effectively relieve the severity of disease， improve respiration function， reduce the times of acute attack of asthma， and have good therapeutic efficacy and safety.