Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Mar;9(1):79-82.
doi: 10.7861/fhj.2021-0116.

Making the case for spirometry as part of the perioperative multidisciplinary team assessment

Thomas Chambers  1 , Mevan Gooneratne  2 , Richa Singh  1 , Ching Pang  2 , Gayle McDonnell  1 , William Ricketts  1
Affiliations
Case Reports

Making the case for spirometry as part of the perioperative multidisciplinary team assessment

Thomas Chambers et al. Future Healthc J. 2022 Mar.

Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and is significantly underdiagnosed in the community. Respiratory impairment is a key risk factor for perioperative morbidity and mortality. The National Institute for Health and Care Excellence (NICE) does not recommend routine spirometry before major surgery. However, in this article, we present the potential benefits of targeted spirometry in high-risk patient groups. Of 183 patients who underwent targeted preoperative spirometry, 25/70 (35.7%) of those with airflow obstruction had no previously known respiratory diagnosis. Of patients with known COPD, 20/46 (43.5%) were not prescribed optimum inhaled therapies for their degree of lung function deficit. Knowledge of lung function in respiratory disease helps to optimise patients perioperatively and facilitate shared decision making regarding the benefits and risk of surgeries. We propose that targeted spirometry should be used as part of the perioperative multidisciplinary team assessment of selected patients.

Keywords: COPD; airflow obstruction; perioperative medicine; shared decision making; spirometry.

PubMed Disclaimer

Figures

Fig 1.
Fig 1.
Criteria for spirometry within the high-risk assessment clinic. Patients were invited for spirometry if they were high risk for respiratory disease and were undergoing one of five types of major surgery. COPD = chronic obstructive pulmonary disease; ENT = ear, nose and throat; GI = gastrointestinal; HPB = hepatobiliary.
Fig 2.
Fig 2.
Areas for optimisation of inhaled therapies. 20/46 patients (43.5%) had room for inhaler optimisation. Trust guidelines advise that patients should be on combined LABA/LAMA inhaler if Medical Research Council dyspnoea score ≥2. COPD = chronic obstructive pulmonary disease; LABA = long-acting beta agonist; LAMA = long-acting muscarinic agonist; SABA = short-acting beta agonist (eg salbutamol).
Fig 3.
Fig 3.
Spirometry results in those invited for testing. COPD = chronic obstructive pulmonary disease; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity.
See this image and copyright information in PMC

References

    1. World Health Organization . The top 10 causes of death. WHO, 2020. www.who.int/en/news-room/fact-sheets/detail/the-top-10-causes-of-death [Accessed 28 June 2021].
    1. Gershon AS, Thiruchelvam D, Chapman KR, et al. . Health services burden of undiagnosed and overdiagnosed COPD. Chest 2018;153:1336–46. - PubMed
    1. Balata H, Harvey J, Barber PV, et al. . Spirometry performed as part of the Manchester community-based lung cancer screening programme detects a high prevalence of airflow obstruction in individuals without a prior diagnosis of COPD. Thorax 2020;75:655–60. - PubMed
    1. Attaallah AF, Vallejo MC, Elzamzamy OM, Mueller MG, Eller WS. Perioperative risk factors for postoperative respiratory failure. J Perioper Pract 2019;29:49–53. - PMC - PubMed
    1. Prytherch DR, Whiteley MS, Higgins B, et al. . POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity. Br J Surg 1998;85:1217–20. - PubMed

Publication types