Anesthesia and Asthma

Updated on May 3, 2017
TahoeDoc profile image

I am a board-certified anesthesiologist in Lake Tahoe, California. I write from the perspective of both a doctor and a patient.

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Risks of Asthma and General Anesthesia

Overall, general (and other types of) anesthesia are very, very safe. The risks of anesthesia are often related to preexisting health problems. As an MD anesthesiologist, I can attest to the fact that, most of the time, even people with significant health issues can be safely anesthetized and awakened with the proper preparation.

Asthma and general anesthesia both affect breathing, so it's no surprise that there are issues that need to be addressed before, during, and after an anesthetic. Asthmatics do have increased risk of some postoperative complications—but for most people, these can be minimized with careful evaluation, prevention, and treatment of asthma symptoms.

Understanding Asthma

Anesthesia Preoperative Evaluation: Asthma

Asthma is described as a chronic medical condition where the small airways in the lungs—the bronchi—swell and constrict. This causes a subjective feeling of shortness of breath and the objective finding of decreased or turbulent air movement heard as wheezing.

During your preoperative evaluation, you will be asked a series of questions about your health involving various body and organ systems. If you have asthma, you will be questioned about the severity and any medications you use to control it.

  • Do you have asthma?
  • How severe is it now?
  • How long have you had it?
  • Do you take any medications for it?
  • Are you having any symptoms now?
  • What are your usual triggers for an attack?
  • Have you ever gone to the ER with asthma?
  • Have you ever been in the ICU for asthma?
  • Have you had pulmonary function tests to assess your asthma?
  • Have you ever had to have a breathing tube placed for asthma?

If you answer yes to any questions that indicate your asthma is severe, you will be asked more specific questions about your symptoms, testing, and treatment.

Schematic of Airway during Asthma Attack

Photo from FDA, public domain
Photo from FDA, public domain | Source

Leading up to your surgery...

  • Use inhalers as usual or as instructed
  • Take other medications as prescribed
  • Avoid triggers
  • Stop smoking
  • See your doctor if you haven't had a recent checkup for your asthma (or any other medical problems)
  • Tell your doctor (surgeon/anesthesiologist) about any symptoms you are having or illnesses in the 2 weeks before surgery

Preoperative Preparations if You Have Asthma

If you have mild asthma, you will likely be instructed to use your "as-needed" inhaler on the morning of surgery. You may also be asked to bring this inhaler to the hospital or surgery center with you.

If your asthma is more severe, you will be instructed to use your inhalers as usual. If you take any oral medications, you will most likely take those on schedule, too. If you take steroids on a chronic basis (orally) for asthma, you may need more workup and optimization before elective surgery. Severe asthmatics require pulmonary function tests and/or a note from your pulmonologist (lung specialist) regarding the ideal management of your obstructive airway disease.

Abnormal Lung Sounds: Ever wonder what your doctor is listening for in your lungs?

In this photo, the number 98 represents the percentage of oxygen saturation. The white, boxy line represents the breathing pattern. A lot of information is provided to the anesthesiologist by the pattern of this line.
In this photo, the number 98 represents the percentage of oxygen saturation. The white, boxy line represents the breathing pattern. A lot of information is provided to the anesthesiologist by the pattern of this line. | Source

Preventing Asthma during Anesthesia: What Your Anesthesiologist Does.

In addition to the very important preventative steps you take, your anesthesiologist is specifically trained to handle asthma-related issues during and after surgery.

Preop

Your anesthesiologist will listen to your lungs before you go to sleep to identify any wheezing or other abnormal breath sounds. Your oxygen level will be measured with a lighted finger clip and he or she will review any test results.

You may be asked to take puffs of your inhalers on the morning of surgery, if you had not already done so.

Airway Management

If possible, your anesthesiologist may try to avoid placing a breathing tube. The breathing tube goes between the vocal cords into the windpipe. Because it is IN the airway, the breathing tube can be irritating and trigger airway constriction and an asthma attack. Very often a breathing tube is mandatory for the type of surgery you are having.

A device called a laryngeal mask airway (LMA) sits in the back of the throat and overlies the airway instead of being placed in it. This causes a bit less airway irritation and may less likely to cause bronchospasm and airway constriction. There are many limitations to use of an LMA, so if your anesthesiologist doesn't use one, there is probably a good reason.

Monitoring

During your anesthetic, your anesthesiologist monitors your oxygen level. The little lighted clip placed on your finger is able to measure the percent of oxygen saturation of your red blood cells in your arterial pulse.

Also, your breathing is monitored while you are anesthetized. During surgery, a ventilator may help you breathe. At the end of surgery, before waking up, you will resume breathing on your own. While the ventilator is being used, the anesthesiologist can get a measurement of your airway pressures. This value will be increased above normal values if your airways are constricted. There are other parameters that can give the anesthesiologist important information about your lungs and breathing, as well.

The rate and depth of your own breathing is assessed as you wake up. The anesthesia provider will listen to your lungs to assess for wheezing or other problems if he or she has any concerns about your asthma.

During and After

If there is any problem with asthma during anesthesia, medications can be given while you are still sleeping. Usually, if there is any issue at all, it is often minor and easily treated with some albuterol sprayed down the breathing tube or some steroids given in your IV.

If you still have any wheezing or signs of constricted airways when you wake up, you can be given a nebulized breathing treatment in the recovery room.

Rarely, in severe asthmatics, it is not possible to remove the breathing tube right at the end of surgery. If the oxygen level is too low or the airway pressure is too high, you can be kept heavily sedated and the breathing tube can be left in for a while to allow more intensive treatment in the ICU.

Are you using your inhaler properly? Are you sure?

Those at risk for more significant problems with asthma after surgery are

  • Severe asthmatics
  • Those whose asthma is not under good control at the time of surgery
  • Asthmatics who smoke
  • Asthmatics with recent respiratory infections
  • Asthmatics presenting for airway surgery
  • Asthmatics presenting for emergency surgery (with less-than-ideal control of asthma)

Who is at Risk of Asthma Complications after Surgery?

For most people with mild to moderate asthma, the risks of anesthesia are minor and not excessive. In other words, even if your lungs do become reactive, it is usually easily treated, sometimes while you are still asleep. The degree of bronchospasm is not severe and doesn't cause concerning drops in the oxygen level or increases in airway pressure on the monitor.

As expected, people with more severe asthma or asthma that is not well controlled going into surgery are more likely to have problems with reactive airways during and after surgery.

Do you know? Take this quiz before looking at the map below.

view quiz statistics

Asthma in America: Ten States with the Highest Prevalence of Adult Asthma (percent of population listed below)

A
hawaii:
Hawaii, USA

get directions

17.6 percent

B
vermont:
Vermont, USA

get directions

17.2 percent

C
rhode island:
Rhode Island, USA

get directions

16.7 percent

D
oregon:
Oregon, USA

get directions

16.2 percent

E
michigan:
Michigan, USA

get directions

15.8 percent

F
washington state:
Washington, USA

get directions

15.8 percent

G
maine:
Maine, USA

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15.7 percent

H
washington, dc:
Washington, DC, USA

get directions

15.5 percent

I
Connecticut:
Connecticut, USA

get directions

15.3 percent

J
Massachusetts:
Massachusetts, USA

get directions

15.3 percent

Prevalence data compiled from statistics of the Centers for Disease Control in the US - 2010 http://www.cdc.gov/asthma/brfss/2010/lifetime/tableL1.htm))

Although, Hawaii (maybe surprisingly) has the highest self-reported asthma rate, the Northeast United States is highly represented in the top ten.

Questions & Answers

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      • profile image

        Yan Jidon Batlayeri 

        2 years ago

        I like this..

        good teaching

      • Monique Graham profile image

        Monique Graham 

        5 years ago from Atlanta, GA

        This is a very informative hub. It grabbed my attention because I am an asthmatic and I experienced some issues while being put under anesthesia last year.

        The anesthesiologist asked me questions about my asthma and did indeed listen to my lungs. Once in the OR I remember anesthesia being administered via IV and a mask being placed over my face. I also remember someone saying something like “take deep breaths, take deep breaths”; however for some reason I could not do so. Mind you, before I’d been taken to the OR I had not been having any issues with my breathing that particular morning. I remember the mask being removed from my face and my name being called. When I came to, someone (I assume a nurse) held an inhaler to my mouth and told me to take a few puffs.

        After that the next thing I remember is waking up in my hospital room being told to slide over from the gurney to the bed.

      • TahoeDoc profile imageAUTHOR

        TahoeDoc 

        6 years ago from Lake Tahoe, California

        Wow, Miz. I'm sorry for your friend - that sounds scary and frustrating. It's no simple matter to get anesthesia with lung issues, as she is finding out by their refusal to do the surgery. Unfortunately, her weight is a compounding factor. It definitely adds to the risk (I have a hub on the subject of obesity as a risk for anesthesia, if it helps?)

        Please wish her luck for me that she gets better, gets what she needs and gets on with her life.

      • MizBejabbers profile image

        Doris James-MizBejabbers 

        6 years ago

        Talk about scary, my friend was told five months ago that she had thyroid tumors and her thyroid needed to be removed. She is overweight and has had a bad persistent cough for 10 or 12 years. She still hasn't had her surgery because they found that her lungs were "cloudy," whatever that means, and are treating her for inflamation. Her heart checks out as strong, but she is being tested for sleep apnea. But we are worried because she is still being treated for this mysterious lung problem. Doctors are still afraid to administer anesthesia. She has been advised that her weight is compounding the problem. I had the same surgery two years ago, and it was a breeze for me. There's no real point to the story except that sometimes we don't know what we are getting into when we face surgery.

      • TahoeDoc profile imageAUTHOR

        TahoeDoc 

        6 years ago from Lake Tahoe, California

        Thank you all so much! I really hope that some things I write help someone. I know how scary it is to face surgery. There is so much to think about and sometimes, patients (I've been one) don't even know what to ask or where to start looking for information.

        Again, thanks all for your feedback.

      • Horatio Plot profile image

        Horatio Plot 

        6 years ago from Bedfordshire, England.

        Nice. Great info as usual. Well written as usual. Easy to understand as usual.

        Hawaii hey? Must be the pineapples!

      • MizBejabbers profile image

        Doris James-MizBejabbers 

        6 years ago

        I had issues when I lived in the Southwestern desert area, but I figured it was the industrial areas that really made it bad. Good hub.

      • profile image

        summerberrie 

        6 years ago

        What valuable information. Thanks. It is interesting about the cluster area of adult asthma.

      • taw2012 profile image

        taw2012 

        6 years ago from India

        Great hub. This is informative and gonna help a lot of people for sure.

      • Marcy Goodfleisch profile image

        Marcy Goodfleisch 

        6 years ago from Planet Earth

        Well, I just got 10 more states on my list of where not to live! I scored zero on the test (I was sure it would be the Midwest, since I had some issues there). I thought California (molds along the coast) would be on the list, too. Hawaii was a surprise, though!

        This hub is a huge comfort - I have had asthma off and on, and when I am vulnerable for it, it is very frightening.

        Thanks for the great information! Voted up and shared.

      • Mmargie1966 profile image

        Mmargie1966 

        6 years ago from Gainesville, GA

        Voted up and awesome! Great Job!

        I bet this will be extremely beneficial to a lot of people!

      • Michael J Rapp profile image

        Michael J Rapp 

        6 years ago from United States

        This Hub will be helpful to people for sure. Up and awesome. You do a great job of presenting the info!

      • wayseeker profile image

        wayseeker 

        6 years ago from Colorado

        Super cool use of the quiz and map combination here--very clever. I also sincerely appreciate the way you bring simple clarity to common medical situations, providing advice and suggestions along the way.

        Thankfully, I don't have much in the way of medical problems right now, but I hope when the next one comes up I can find a TahoeDoc Hub on it!

        wayseeker

      • ElizaDoole profile image

        Lisa McKnight 

        6 years ago from London

        Great hub and a beautiful layout. The asthma seems to be across the middle of the states.

      • TFScientist profile image

        Rhys Baker 

        6 years ago from Peterborough, UK

        Loved the use of the map capsule. Sound advice, informative videos and an easy to read format. In your experience, how do you think asthma rates are changing?

        Voted up and interesting

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