There are 4 million high school athletes in the United States, and there are 30 million athletes under age 18 yr competing in organized sports. The prevalence number of emergency room visits and deaths from asthma are significant. Medical clearance is required by all states for participation in high school sports. This article discusses the issues regarding the medical screening of the athlete and how asthma fits into the process. The preparticipation sports physical is an overlooked and underutilized opportunity to improve asthma diagnosis and management in adolescents.