Anesthesiologists encounter asthmatic patients routinely. This common disease frequently complicates the perioperative care of those patients who live with it and can occasionally lead to life-threatening complications. This review takes the anesthesiologist's perspective to discuss asthma and how asthmatic patients can be safely guided through an anesthetic. We will discuss frequently used asthma medications, pre-operative disease optimization, management of intra-operative bronchospasm, and post-operative considerations for asthmatic patients. Anesthesiologists can make a positive difference in the outcomes of these patients with proper preoperative evaluation using a stepwise approach to disease management and by minimizing bronchoconstriction and effectively treating it when it develops.