What is the perioperative management of asthma and COPD medications?

Updated: Jan 09, 2018
  • Author: Nafisa K Kuwajerwala, MD; Chief Editor: William A Schwer, MD  more...
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Answer

Answer

In the perioperative period, beta-agonists and bronchodilators should not be discontinued in patients with asthma, and beta-agonists and atropine analogs should not be discontinued in patients with chronic obstructive pulmonary disease. The patient should take the usual inhaled medication or tablet until the day of surgery and also on the morning of the operation.

During the procedure, while the patient is under anesthesia, these drugs are usually not needed. Following surgery, if the endotracheal tube is still present, the inhaled medication can be continued. Optimization of treatment for chronic obstructive pulmonary disease is critical, and some patients require an increase in their steroid dose for 1-2 weeks preoperatively.

Consider preoperative bronchodilator therapy in those with a forced vital capacity of less than 1 L or a forced expiratory volume in 1 second of less than 500 cm3, especially if improvement occurs after treatment. In the case of productive cough, reschedule an elective surgery and treat the patient with a course of antibiotics to reduce the risk of bronchospasm.

Postoperative analgesia also plays an important role. Judicious use of narcotics and diligent monitoring for respiratory depression is important in patients with respiratory compromise. Instruct patients to breathe deeply and cough to avoid atelectasis. Counsel patients on the effects of smoking and urge them to stop. Patients should be advised to stop smoking 2 months prior to elective operations to maximize the effect of smoking cessation, [9] or for at least 4 weeks to benefit from improved mucociliary function and some reduction in postoperative pulmonary complication rate. [10] When a person who smokes stops for a short time before surgery, the use of transdermal nicotine replacement is helpful to alleviate symptoms of withdrawal.

For patients on long-term steroid therapy, increase the dose on the day of surgery (hydrocortisone 100 mg q8h for 24 h), then decrease the dose by 50% every day until back to the usual dose (prednisone is 4 times stronger than hydrocortisone).


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