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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

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.

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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.

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