👉👉 🇺🇸 All Posts 🇬🇧 / 🇯🇵 記事一覧 🇯🇵 👈👈
♦️ Introduction
Your COPD patient is on the schedule next week. You open the chart — wheezing, recent cough. 🤔 Should you go ahead, optimize, or postpone?
Let’s break down what the latest GOLD 2025 guidelines recommend.
🫁 Step 1: Confirm Stability Before Surgery
The #1 rule from GOLD 2025: no recent exacerbations.
If the patient had worsening dyspnea, purulent sputum, or needed antibiotics in the past 4 weeks, elective surgery should wait.
Acute flares dramatically raise the risk of postoperative pulmonary complications.
💨 Step 2: Continue Maintenance Inhalers
Never stop inhalers before surgery.
Continue beta-2 agonists, anticholinergics, and inhaled corticosteroids through the day of surgery to maintain airway tone and minimize intra-operative bronchospasm.
🧪 Step 3: Assess the Real Risk
Not all COPD cases need a full PFT panel.
Reserve testing for:
- Thoracic or high-risk procedures
- FEV₁ suspected < 50%
- Chronic CO₂ retention
For stable, moderate-risk cases, a focused clinical assessment often gives enough information.
⚙️ Preoperative Optimization Works
Even 2 weeks of focused prep helps:
- Respiratory physiotherapy & incentive spirometry
- Smoking cessation (the longer, the better — ≥ 8 weeks ideal)
- Nutrition optimization
Don’t forget to check hemoglobin and albumin — low albumin predicts poor outcomes and is often correctable.
📝 Take Home Points
- Confirm stability (no recent flare), keep all inhalers, and optimize nutrition.
Stable COPD = safer anesthesia.
📚 References & Further reading
- GOLD 2025 Report
- Lee HJ et al. Tuberc Respir Dis. 2025; 88(1): 90-108