Lung cancer remains the leading cause of cancer deaths, contributing to 25% of cancer deaths each year. It is significantly associated with smoking and often presents in smokers who have preexisting lung disease, such as chronic obstructive pulmonary disease (COPD). The gold standard for lung cancer is surgical resection, however it is often complicated by patients with underlying COPD and are not suitable for surgery due to their cardiopulmonary function [1]. The gold standard for treating COPD is with bronchodilators, such as tiotropium and salmeterol. Bronchodilators include a wide variety of drugs from short-acting ones, like B-2 agonists, such as albuterol inhalers, to more long-acting ones like corticosteroids. They work by relaxing the muscles of the lungs and widen the airways allowing for more oxygen inflow and outflow. The evaluation of bronchodilators for preoperative and postoperative use in patients with superimposed lung cancer and COPD is important for improvement in surgical outcomes, pulmonary function, and quality of life. Likewise, in other pulmonary conditions such as asthma, research and guidelines have been formulated to optimize pharmacologic use before surgery to minimize intra- and post-operative complications.  

Some studies have shown that use of bronchodilators preoperatively can significantly improve postoperative pulmonary function in patients with untreated COPD and lung cancer and may even facilitate surgical resection [2,3]. Thus, in patients who are poor surgical candidates due to their underlying COPD, bronchodilators may be useful for improving patient’s pulmonary function to further undergo curative cancer treatment. In terms of postoperative use, one study found that patients with COPD who underwent lobectomies, or removal of part or a whole lung, had significant improvement of respiratory function following bronchodilator use compared to those who did not use bronchodilators postoperatively. They found improvements in not only lung capacity but also in diaphragm movement, allowing for better overall lung movement [1]. Further, they found that adjuvant bronchodilator therapy considerably improved health related quality of life after surgery as reported by patients with moderate to severe COPD.  

In terms of surgical patients with other prevalent pulmonary conditions, such as asthma, guidelines to optimize lung function and use of bronchodilators pre and postoperatively exist. Asthma often creates a challenge for general anesthesia due to underlying airway inflammation which considerably increases the risk of surgical complications [5,7]. However, unlike with COPD, asthma is associated with significant reversal of airway obstruction with the use of bronchodilators. The Global Initiative for Asthma proposed a treatment regimen for managing asthma, including preoperative guidelines. For patients who have poorly controlled asthma and are undergoing elective surgery, additional therapy with strong bronchodilators, such as corticosteroids, is recommended prior to surgery. For uncontrolled asthmatics undergoing emergency surgery, where there is no possibility for preoperative pharmacotherapy, short-term premedication with B-agonists, like albuterol, is recommended when possible [5,6]. These recommendations are all made on the premise of reducing intraoperative bronchospasms, which can be life-threatening.  

Overall, guidelines involving pre and post-operative bronchodilator use are important for minimizing risks of surgery and improving health related outcomes and quality of life in surgical patients with existing pulmonary diseases.  

References 

1. Suzuki, Hidemi, et al. “Efficacy of Perioperative Administration of Long-Acting Bronchodilator on Postoperative Pulmonary Function and Quality of Life in Lung Cancer Patients with Chronic Obstructive Pulmonary Disease. Preliminary Results of a Randomized Control Study.” Surgery Today, vol. 40, no. 10, 25 Sept. 2010, pp. 923–930, 10.1007/s00595-009-4196-1. 

2. Kobayashi, Seiichi, et al. “Preoperative Use of Inhaled Tiotropium in Lung Cancer Patients with Untreated COPD.” Respirology, vol. 14, no. 5, July 2009, pp. 675–679, 10.1111/j.1440-1843.2009.01543.x.  

3. Bölükbas, Servet, et al. “Short-Term Effects of Inhalative Tiotropium/Formoterol/Budenoside versus Tiotropium/Formoterol in Patients with Newly Diagnosed Chronic Obstructive Pulmonary Disease Requiring Surgery for Lung Cancer: A Prospective Randomized Trial.” European Journal of Cardio-Thoracic Surgery, vol. 39, no. 6, June 2011, pp. 995–1000, 10.1016/j.ejcts.2010.09.025.  

4. Shin, Sun Hye, et al. “Effect of Perioperative Bronchodilator Therapy on Postoperative Pulmonary Function among Lung Cancer Patients with COPD.” Scientific Reports, vol. 11, no. 1, 16 Apr. 2021, 10.1038/s41598-021-86791-1.  

5. Applegate, Richard, et al. “The Perioperative Management of Asthma.” Journal of Allergy & Therapy, vol. 01, no. S11, 2013, 10.4172/2155-6121.s11-007.  

6. Liccardi, Gennaro, et al. “Bronchial Asthma.” Current Opinion in Anaesthesiology, vol. 25, no. 1, Feb. 2012, pp. 30–37, 10.1097/aco.0b013e32834e7b2e.  

7. Azhar, Naheed. “Pre-Operative Optimisation of Lung Function.” Indian Journal of Anaesthesia, vol. 59, no. 9, 1 Sept. 2015, pp. 550–556, www.ncbi.nlm.nih.gov/pmc/articles/PMC4613401/, 10.4103/0019-5049.165858.