Currently, systemic corticosteroid treatment is considered the most effective medication for control of chronic asthma and rescue of acute exacerbation. Children can have poorly controlled asthma for numerous reasons. It is important to identify the underlying causes that contribute to poorly controlled asthma in each patient so that management strategies can be personalized to achieve the best outcomes. We have identified a biological basis for poor corticosteroid treatment response that can be used to distinguish a subgroup of children with asthma who respond poorly to treatment. nasal VNN1 and FKBP5 expression might be a clinically useful biomarker to identify a subset of children with difficult to- treat asthma with a biologic cause for poor corticosteroid response. Targeting the VNN1 and FKBP5 pathways in this subset might be a useful therapeutic strategy to enhance corticosteroid response.