The Risks of Undergoing Surgery If You Have Asthma

There are several things to consider when you're planning surgery. If you have asthma, an increased risk of certain surgical complications because of your condition is one of them. Having severe asthma or experiencing asthma-associated issues in the weeks or months before surgery further increases the likelihood of developing an adverse event, such as an infection, after your procedure.

To reduce your chances of complications, your pre-operative evaluation will include an assessment of your asthma control and lung function. Your surgery and surgical anesthesia will need to be planned with your asthma status in mind.

How Asthma Affects Outcomes

Asthma may predispose you to a range of surgical complications, some of which can be so severe that they impair respiratory function and potentially necessitate you receiving respiratory support.

Some of the surgical complications that children and adults who have asthma may face stem from the effects of anesthesia (local or general) and how it affects breathing and the lungs themselves. Others relate to predispositions for certain health issues that can occur after surgery in general.

Bronchospasm

Sudden narrowing of the airways in the lungs prevents oxygen from reaching your lungs, even if you are receiving oxygen through a surgical ventilator.

Asthma predisposes you to bronchospasm and hyperreactivity of the airways, and intubation for anesthesia can trigger these reactions.

Pneumonia

Asthma places you at risk of developing post-surgical pneumonia. This is believed to occur due to a number of factors.

Your cough reflex is weakened when you are recovering from anesthesia, so you can't clear infectious organisms (like viruses and bacteria) as effectively as usual.

In addition, airway manipulation from general anesthesia can lead to aspiration (breathing in your saliva), which causes aspiration pneumonia. The airway inflammation that is part of asthma compounds these anesthesia effects.

Systemic Infections

Decreased physical activity during surgical recovery can lead to post-operative infections. This can progress to sepsis, a severe systemic reaction.

When you have asthma, you are more prone to lung infections at any time. The immune system issues associated with asthma particularly put you at an increased risk of postoperative infections like septicemia (blood infection) and urinary tract infections (UTIs). Asthma-related inflammatory dysfunction can predispose you to sepsis as well.

Partially Collapsed Lung

Anesthesia reduces your ability to breathe on your own—and it can take hours to recover. When you have asthma, this period can extend to days.

In the meantime, your weakened breathing means that your airways may not open as they should with each breath. Serious lung damage in the form of atelectasis (partial collapse of the lungs) can occur.

You can experience severe shortness of breath with atelectasis. While you may improve over time, and it may take months or even longer for your lungs to heal.

Hypoxemia

Extensive areas of bronchospasm or prolonged bronchospasm can decrease the oxygen concentration in the blood, leading to hypoxemia. This can result in life-threatening problems, including brain death or kidney damage.

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What Further Increases Your Risk

While any degree of asthma increases the chances that you could have a postoperative complication, there are certain circumstances that can raise the risk even further:

• Extent of your procedure: Generally, major procedures are riskier than minor surgeries when you have asthma.
• Severity of your asthma: Severe asthma is a greater risk factor for surgical problems than mild or moderate asthma.
• Degree of asthma control: If your asthma isn't well-controlled, your risk of adverse post-surgical events increases. You could have poorly controlled asthma if you aren't taking your medication as directed, your medication isn't right for you, or you cannot avoid exposure to certain triggers.
• Steroid use: Asthma that requires very high doses of steroids is associated with a high chance of postoperative complications.
• Health before surgery: Frequent asthma attacks or infections (especially lung infections) in the months prior to surgery are predictors of worse outcomes after surgery.

Preoperative Preparation

When you have asthma, your medical team will work on planning your procedure to minimize the risk of adverse events during and after surgery. This includes getting your asthma under optimal control, potentially by adjusting your medications if necessary.

You will likely need to see your asthma specialist for an evaluation. This may include pulmonary function tests such as forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). These can provide an objective assessment of your lung function and can guide adjustments in your asthma treatment.

If there are any concerns, your asthma specialist may alert your surgical and anesthesia team of special considerations they should factor into your surgical plan.

Anesthesia Planning

Because having asthma poses surgical risks, some of which relate to anesthesia, planning for this part of your procedure is a crucial part of maintaining your safety. Your healthcare provider will determine which anesthesia medications and procedures are best for you.

While asthma-associated complications can occur with general anesthesia or regional (local) anesthesia, regional anesthesia isn't as risky because it doesn't involve airway manipulation. As such, your healthcare providers might favor its use if you are not having a major procedure that necessitates general anesthesia.

Steps You Can Take

There are things you can do in advance of your procedure to limit your risk of developing surgical complications if you have asthma.

• Avoid asthma triggers, especially in the weeks leading up to your procedure.
• Take your medication as directed to optimize your lung function and stabilize your health.
• If possible, reduce stress, as it can exacerbate your asthma and raise your susceptibility to surgical and post-operative complications.

If you have asthma and are a smoker, it's important that you quit smoking because smoking worsens your lung function. Smokers are, in fact, at greater risk for a variety of surgical complications, whether or not they have asthma.

It isn't necessarily a good idea to quit smoking cold turkey right before a procedure because nicotine withdrawal can cause a number of effects that will complicate your care. Still, make sure you are clear about cessation expectations by talking to your care team, and ask for help quitting if you need it.

After Surgery

During your recovery, you will need close monitoring of your pulmonary function, as well as postoperative strategies to reduce your chances of developing respiratory issues.

You will need to continue to use your controller medications to maintain consistent control of your asthma. If there are any changes to your prescriptions while you are recovering in the hospital or at home, your medical team will specify instructions.

Your medical team may teach you how to do breathing exercises. You will be instructed to take deep breaths and to repeat this process several times per day. This type of exercise expands your lungs and strengthens your respiratory muscles, and can help prevent postoperative complications.

Your healthcare provider or respiratory therapist might also instruct you to use a spirometer to measure the air as you inhale and exhale so that you can keep track of the targets you need to reach.

You will also be advised regarding increasing your physical activity, which is important because staying sedentary can lead to infections.

Pain Control

Pain is a major factor that prevents people from walking and breathing deeply after surgery. One of the reasons your healthcare providers will prescribe medications for pain control is to help you stay active for a healthier recovery.

Keep in mind that excessive use of pain medications makes you sleepy (and, therefore, less active) and impairs breathing. You will want to make sure that you don't take so much pain medication that you feel lethargic.

A Word From Verywell

Living with asthma involves a number of lifestyle adjustments. Your asthma can be a factor when it comes to managing any other medical conditions that you have. You can achieve great outcomes, but you need to make sure that you and your medical team take any necessary special precautions with respect to your asthma whenever you need medical or surgical care.