A.D., 15 years old, was seen in the preadmission testing unit in preparation for her elective spinal surgery. She has a history of mild asthma since age 4, with at least one attack per week. In an acute attack, she will have mild dyspnea, diffuse wheezing, yet an adequate air exchange that responds to bronchodilators. She was sent to pulmonary health services for a consult with a specialist and pulmonary function studies to clear her for surgery. The anesthesiologist reviewed the pulmonologist's report.

Her prebronchodilator spirometry showed a mild reduction in vital capacity but with a moderate to severe decrease in FEV1 and FEV1/FVC ratio. After bronchodilator administration, there was a mild but insigni?cant improvement in FEV1. The postbronchodilator FEV1 was 55% of predicted and was considered moderately abnormal. The ?ow volume loops and spirographic curves were consistent with air?ow obstruction.

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