Chronic Lung Disease
- Known chronic lung disease is an important patient-related risk factor for postoperative pulmonary complications.
- Unadjusted relative risks of postoperative pulmonary complications have ranged from 2.7 to 6.0 for those with uncontrolled chronic lung disease.
- Patients with chronic obstructive pulmonary disease (COPD) should be aggressively treated to achieve their best possible baseline level of function. In general, indications for specific treatments are the same as those for patients not preparing for surgery.
- All patients with symptomatic COPD should receive daily inhaled ipratropium or tiatropium. Inhaled beta-agonists should be used as needed for symptoms and wheezing in patients with COPD in the perioperative period
- Theophylline should NOT be added to the regimen of a stable patient in preparation for surgery unless it would be used in the nonoperative setting.
- Patients with COPD and persistent wheezes or functional limitations despite bronchodilator therapy should be treated with perioperative glucocorticoids