Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. It is currently the fourth leading cause of death in the world.1 An estimated 3 million people have COPD in the UK, of whom 2 million have undiagnosed COPD.2 It is responsible for over 30,000 deaths, 1.4 million General Practitioner consultations, a million hospital bed days and it costs the NHS over £800 million each year.3
Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation1,2,4,5 that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. It includes chronic bronchitis and emphysema.
The most common respiratory symptoms of COPD include dyspnoea, cough and/or sputum production.1
There is no single diagnostic test for COPD. Making a diagnosis relies on clinical judgement, based on a combination of history, physical examination and confirmation of airflow obstruction using spirometry.2,4
During assessment, clinicians assess the severity of airflow limitation, the impact of disease on the patient’s health status, and the risk of exacerbations, hospital admissions, or death in order to guide therapy.1
Classification of COPD depends on FEV1/FVC and FEV1% predicted. NICE, ATS/ERS, and Gold classifications are below:5
Treatment of COPD is guided by the severity of lung impairment, symptoms such as dyspnoea, the amount of cough and sputum production, and how often a patient experiences an exacerbation. When dyspnoea limits activity or quality of life, COPD should be treated with once- or twice-daily maintenance long-acting anticholinergic and β-agonist bronchodilators. Patients with acute exacerbations may benefit from the addition of inhaled corticosteroids, particularly those with elevated peripheral eosinophil levels.4
A thorough preoperative assessment is crucial in patients with COPD. Assessing the severity of disease will help determine the risk of postoperative complications.5
Regional anaesthesia techniques are preferred when possible, to limit the risk of respiratory compromise or respiratory failure in patients with COPD.
General anaesthesia, and, in particular, tracheal intubation and intermittent positive pressure ventilation (IPPV), are associated with adverse outcomes in patients with COPD. Such patients are prone to laryngospasm, bronchospasm, cardiovascular instability, barotraumas, and hypoxaemia, and have increased the rates of postoperative pulmonary complications5 such as delirium.
When a general anaesthetic is required, clinicians must be aware of risk of haemodynamic compromise and place an arterial catheter for continuous blood pressure monitoring and blood gas analysis. Preoxygenation should be used in any patient who is hypoxic on air before induction. In patients with severe COPD and hypoxia, CPAP during induction may be used to improve the efficacy of preoxygenation and reduce the development of atelectasis.5
Before extubating, it is important to optimize the patient's condition. The neuromuscular blocking agent should be fully reversed and the patient warm and well oxygenated.5
Learn more about the different types of anaesthesia and what a nurse must do for Regional, Local and General Anaesthesia.
After surgery, patients with severe COPD need close monitoring to avoid respiratory failure or postoperative chest infections. Patients with severe disease or significant co-morbidities should be managed in a high dependency setting capable of regular monitoring of arterial blood gases and providing non-invasive mechanical ventilation if required.5
Hypoventilation as a result of residual anaesthesia or opioids should be avoided, as this may lead to hypercarbia and hypoxia. Use of saline nebulization, suctioning, and physiotherapy are useful to avoid sputum plugging and ventilatory failure.5
Effective analgesia is a significant determinant of postoperative pulmonary function. Epidural analgesia is a particularly attractive option as it reduces the risk of respiratory failure because of excessive sedation from opioids. It should, therefore, be considered if appropriate to the surgical procedure.5
Chronic obstructive pulmonary disease is a complicated disease requiring intensive treatment. When undergoing surgery, patients with COPD, should have regional anaesthesia when possible. When general anaesthesia is required, particular care intra and post operatively focuses on maintaining haemodynamic balance, avoiding respiratory compromise and minimising risk of chest infections.
My name is Andreia Trigo RN BSc MSc, I am a nurse consultant with over a decade of experience in anaesthesia, sedation and pain management.
This involves patient care, as well as lecturing at post grad level on these topics, presenting at conferences and co-developing a very successful sedation course at SedateUK. My passion for creating safer environments for patients and professionals led me to collaborate with Medtronic and share my knowledge and expertise with our professional community.
The content of this article is written by a blogger with whom Medtronic has a relationship. However, the contents represent the personal objective views, comments and techniques of the blogger and are not statements from Medtronic. To the extent this material might contain images of patients or any material where a copyright is held by a third party, all necessary written permissions from the patient or copyright holder, as applicable, with respect to use, distribution or copying of such images or copyrighted materials has been obtained by the blogger.
1. Global Initiative for Chronic Obstructive Lung Disease (2016) Pocket Guide to COPD diagnosis, management and prevention. Available at: https://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf
2. NICE (2015) Chronic obstructive pulmonary disease. Available at: https://www.nice.org.uk/Media/Default/Standards-and-indicators/QOF%20Indicator%20Key%20documents/nm105-copd-guidance.pdf
3. Primary Care Respiratory Society UK (2013). Reviewing people with COPD. Available at: https://www.pcrs-uk.org/sites/pcrs-uk.org/files/os19_copd_review.pdf
4. Jama Network (2019) Diagnosis and Outpatient Management of Chronic Obstructive Pulmonary Disease: A Review. Available at:https://jamanetwork.com/journals/jama/article-abstract/2725693
5. Khetarpal et al (2016) Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries. Available at: http://www.aeronline.org/article.asp?issn=0259-1162;year=2016;volume=10;issue=1;spage=7;epage=12;aulast=Khetarpal
6. American Lung Association. Learn About COPD. Available at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd