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Background: Non-adherence to asthma treatment is a contributing factor for poorly controlled asthma. Aim: The aim of this systematic review is to explore patients' perceptions of their inhaled asthma treatment, and how these relate to adherence, using both qualitative and quantitative data. Methods: Pre-determined search terms and inclusion criteria were used to search electronic databases (The Cochrane Library, MEDLINE, EMBASE and PsycINFO). Two researchers screened titles and abstracts using the Rayyan web app and data were extracted in relation to psychological components (beliefs about, and attitudes towards, medicines) and adherence. Results: Of 1638 papers, 36 met the inclusion criteria. Key themes were: Perceived need for treatment -all 12 studies using the BMQ to measure patients' perceived need for treatment found that patients' beliefs about their necessity for treatment were associated with adherence-; Concerns about treatment -immediate and longterm side effects (58%), worries about safety (19%), and potential addiction to asthma medication (31%)-; and Perceived social stigma -22% of studies reported that embarrassment contributed to poor adherence. Conclusions: Acknowledging and addressing patient treatment beliefs and perceptual barriers to adherence is integral to designing adherence interventions for asthma patients. Further research is needed to better our understanding of the relationship between treatment perceptions and adherence.