Abstract
Anesthesiologists encounter asthmatic patients routinely. This common disease frequently complicates the perioperative care of those patients who live with it and can occasionally lead to life-threatening complications. This review takes the anesthesiologist’s perspective to discuss asthma and how asthmatic patients can be safely guided through an anesthetic. We will discuss frequently used asthma medications, pre-operative disease optimization, management of intra-operative bronchospasm, and post-operative considerations for asthmatic patients. Anesthesiologists can make a positive difference in the outcomes of these patients with proper preoperative evaluation using a stepwise approach to disease management and by minimizing bronchoconstriction and effectively treating it when it develops.
Highlights
Asthma is a chronic pulmonary disease characterized by airway inflammation and hyper-responsiveness resulting in episodic wheezing, coughing, breathlessness, chest tightness, and reversible airflow obstruction [1]
Asthma prevalence varies by region, with published reports ranging from 0.7% to 18.4%
Leukotriene pathway modifiers are used as second-line controller agents. They are thought to be very useful in specific asthma environments such as exercise-induced, viral-induced, and aspirininduced asthma [1,18]
Summary
Asthma is a chronic pulmonary disease characterized by airway inflammation and hyper-responsiveness resulting in episodic wheezing, coughing, breathlessness, chest tightness, and reversible airflow obstruction [1]. Others have reported similar data, with some experts calling the recent increase in asthma prevalence an “epidemic” [4,5] Despite these concerns, the overall number of asthma-related hospitalizations and deaths has decreased, possibly due to improved prevention of attacks through inhaled steroid use and novel pharmaceutical agents introduced over the past decade [6]. In this article we will discuss frequently used asthma medications, preoperative disease optimization, management of intraoperative bronchospasm, and postoperative considerations for asthmatic patients. As the disease increases in severity, the number and types of medications used to treat the patient increase This model of increasing therapy based on symptom control is applied to preoperative preparation of asthmatics (Figure 1). Systemic corticosteroids are reserved for individuals with severe and uncontrolled asthma
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