Perioperative Management of Patients with Asthma-COPD Overlap Syndrome - Where Do We Stand? A Case Report-Based Discussion

Postoperative pulmonar y complic ations (PPCs) are associa ted with a signific ant morbidity and mortality; prevention and management strategies depend greatly on the patients’ comorbid conditions. Chronic Obstructiv e Pulmonar y Disease (COPD) is a well-kno wn risk factor for PPCs, but controlled Asthma does not appear to be so. On the other hand, the role of Asthma-C OPD Overlap Syndrome (ACOS) as a risk for PPCs is yet to be studied. While there is a guidance for the periope rative risk reduction and management of COPD and Asthma, specific guidance for ACOS is also lacking. As a consequence, physicians tailor their manag ement by conside ring both the componen ts. We present a case of a 74-year-old man with ACOS, diagnose d with invasive bladder carcinoma. He was taken for laparoscopic radical cystectomy and ileal conduit. Although he had an uneventful surgery, we lost him on the seventh postoperative day due to multiple complic ations, including PPCs. The case highligh ts the need for conside ring the ACOS separately as a risk and calls f or a specific r oadmap f or periope rative manag ement. 1. Asthma-C OPD Ov erlap S yndrome pa tients appe ar to be a t high risk of PPCs 2. There is a lack of evidence-based guidance and literature to tailor the management of such pa tients to reduce the periope rative risk s for PPCs 3. It is high time to delinea te the ACOS patients from Asthma and COPD, study them in context to PPCs and periope rative outcome so that specific guidance can be developed.