There are no evidence-based recommendations for the preoperative evaluation of patients with RLD.

The management of patients with RLD depends upon the underlying etiology. For example, obesity may also be associated with sleep-disordered breathing and should be evaluated as such (Chap. 29). Other diseases, such as sarcoidosis and hypersensitivity pneumonitis, can have concomitant airway hyperreactivity and should be treated similarly to chronic obstructive pulmonary disease (Chap. 28) [7].

As with all patients with pulmonary disease, evaluation should include a detailed history of functional status and other risk factors for postoperative pulmonary complications (Chap. 27) [9].

Consider an arterial blood gas, as this may be useful in estimating perioperative oxygenation and ventilation needs [7, 10].

A chest X-ray is only useful in patients with acute dyspnea or if comparison studies are available to monitor for progression of disease [7, 10].

Spirometry is not useful unless concomitant undiagnosed obstruction is suspected [8].

The symptoms of RLD are nonspecific and patients generally present with dyspnea and cough [1]. A careful history should assess for mobility, dyspnea on exertion, and other markers of fitness [9].

Chest radiographs are generally only useful for evaluating acute dyspnea. CT scans are only indicated if tracheal compression or other pathologic conditions are suspected [7, 10].

Spirometry is useful as an initial assessment of lung function, but more detailed PFTs, including lung volumes and DLCO, are necessary to diagnose restriction and can give further insight as to the underlying cause [2, 3, 5].

Consider an arterial blood gas in patients with O2 dependence or severe dyspnea as this may help predict perioperative oxygenation and ventilation [7, 10].