© Springer International Publishing Switzerland 2015
Molly Blackley Jackson, Somnath Mookherjee and Nason P. Hamlin (eds.)The Perioperative Medicine Consult Handbook10.1007/978-3-319-09366-6_2828. Asthma and COPD
(1)
Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
Background
Patients with asthma and chronic obstructive pulmonary disease (COPD) have an increased risk of postoperative pulmonary complications including pneumonia, atelectasis, and respiratory failure [1]. However, mild to moderate asthma has not been shown to pose significant perioperative pulmonary risk [2]. For patients with known asthma or COPD, detailed examination and history are usually enough to assess severity; preoperative pulmonary function tests (PFTs) are useful only if obstructive lung disease is suspected but not previously documented.
Preoperative Evaluation
History and physical should focus on baseline exercise tolerance and any recent decline; triggers for asthma or COPD exacerbation; signs of active respiratory infection such as fever, purulent sputum, and worsening cough; and history of steroid use.
PFTs with spirometry should be reserved for patients who are suspected of, but have not yet been diagnosed with, chronic obstructive pulmonary disease or asthma [2].
Perform an electrocardiogram (ECG) in patients with severe COPD to assess for right heart strain.
Consider an arterial blood gas (ABG) in patients suspected to have baseline CO2 retention.
Routine chest radiographs in patients with stable COPD or asthma are seldom helpful unless guided by symptoms or physical examination findings suggestive of new or worsening disease [2]. However, bullous disease seen on a chest X-ray increases the risk of perioperative pneumothorax.
Perioperative Management
Preoperative Considerations
Delay purely elective surgery for patients with acute exacerbations of asthma or COPD.
Recommend smoking cessation; start nicotine replacement therapy if indicated.
Attention should be given to patients with steroid dependence, as they may need perioperative stress dose steroids (see Chap. 14).
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