Clinical assessment
Consult the patient’s general and specialist practitioners about their medical conditions, drug therapy, surgical history and functional status; functional status can be assessed using the Duke Activity Status Index (DASI) questionnaire1. Optimise drug therapy and management of respiratory conditions before the procedure, including encouraging physical activity if appropriate. See also Periprocedural management of patients with cardiovascular disease and Periprocedural management of adults with diabetes for nonrespiratory considerations.
The potential harms and expected benefits of the procedure must be considered for each patient. Refer to a perioperative specialist if appropriate, particularly for complex patients. Patients waiting for elective procedures will usually have an appointment before the procedure to determine their periprocedural risk.
Consult the anaesthetist to determine if any drugs need to be withheld before the procedure. The patient’s usual inhaler therapy is usually continued unless advised otherwise by the specialist or anaesthetist.
Encourage and assist patients to stop smoking before their procedure to improve postprocedural outcomes. Stopping smoking for even one day can lower carboxyhaemoglobin and nicotine levels, and improve the delivery of oxygen to tissues. Longer periods of smoking cessation have additional benefits, including improved wound healing after 3 weeks, reduced sputum volume and improved pulmonary function after 8 weeks, and improved immune function after 6 months. If practical, postpone the procedure until the patient has stopped smoking. See Smoking cessation for suggested strategies.
Before a procedure, consider screening for sleep-disordered breathing (eg obstructive sleep apnoea, obesity hypoventilation syndrome). Questionnaires such as the STOP-Bang questionnaire2 can be useful to identify patients likely to have sleep apnoea; see Obstructive sleep apnoea in adults for more information.
If preprocedural assessment identifies any undiagnosed respiratory conditions, investigate and manage these conditions before the procedure, if practical.
Patients who use continuous positive airway pressure (CPAP) (eg for sleep-disordered breathing), should usually be instructed to bring their CPAP machines and associated equipment to hospital to be used after the procedure. However, CPAP may be contraindicated after some procedures.
Consider the need for venous thromboembolism (VTE) prophylaxis.