PERIOPERATIVE MANAGEMENT OF BRONCHODILATORS AND CORTICOSTEROIDS IN COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE) SURGICAL PATIENTS

Abstract

Patients with chronic obstructive pulmonary disease (COPD) who have surgery are at high risk of having a postoperative pulmonary complication, and close optimization of pharmacological care during the perioperative period is necessary. Long-term inhaled bronchodilators, specifically long-term combined β 2-agonists and muscarinic antagonists (LABA + LAMA) should be maintained up until surgery day and restarted the next day after the operation to maintain lung function and minimalize symptom management load. ICS (inhaled corticosteroid) as Bronchodilator therapy is indicated in increasing airflow and de-escalating inflammation when inhaled corticosteroids and bronchodilators are given together in the patients with high frequent exacerbations or eosinophilic phenotype with consideration of pneumonia complications with increased dosage. Systemic corticosteroids (e.g. 3-5 days of methylprednisolone before surgery) can help to relieve airway reactivity during intubation, or in patients within recent exacerbations but have to be considered on an individual risk benefit basis because of the risk of causing wound healing complications. Steroid-treated patients who are chronically steroid-receptive might need stress-coverage during surgery to avoid adrenal sufficiency. Smoking cessation, chest physiotherapy, and pulmonary rehabilitation started days prior to elective operations should be considered in preoperative optimization as well. In summary, persistent bronchodilator usage, particularly dual long acting, is the mainstay of perioperative care in COPD with ICS added selectively, systemic steroids only as needed, and adjunctive nonpharmacologic treatment as a multidisciplinary approach to reduce complications and improve results.