From the Guidelines
Based on the pulmonary pre-operative evaluation, I recommend proceeding with the colonoscopy with specific precautions due to the patient's history. The patient should continue her Breztri through the day of the procedure to maintain optimal asthma control. Given her previous resuscitation event during colonoscopy related to excess sputum production, I suggest pre-medication with a short course of oral corticosteroids (prednisone 40mg daily for 3 days before the procedure) to reduce airway inflammation and secretions, as recommended by the expert panel report 3 (epr-3) guidelines for the diagnosis and management of asthma 1. Additionally, administering nebulized albuterol 2.5mg immediately before the procedure can help optimize bronchodilation. The anesthesia team should be informed of her history and prepared with appropriate airway management equipment. During the procedure, careful suctioning of secretions and monitoring of oxygen saturation are essential. The patient should be positioned with head elevation if possible to reduce aspiration risk.
Some key considerations for the patient's bowel preparation include:
- Providing verbal and written patient education instructions for all components of the colonoscopy preparation, as recommended by the US Multi-Society Task Force on Colorectal Cancer 1
- Limiting dietary modifications to the day before colonoscopy for ambulatory patients at low risk for inadequate bowel preparation, as recommended by the US Multi-Society Task Force on Colorectal Cancer 1
- Considering the use of a split-dose bowel preparation regimen, as recommended by the US Multi-Society Task Force on Colorectal Cancer 1
These recommendations are justified because while her asthma is currently well-controlled with normal PFTs and a negative chest CT, her specific history of respiratory complications during previous colonoscopy warrants these preventive measures to ensure airway patency and prevent bronchospasm during the procedure. Post-procedure, close monitoring for at least 2 hours is advisable before discharge.
From the Research
Pre-Operative Respiratory Pulmonary Examination Recommendations
The patient's history of asthma, current treatment with Breztri, and previous complications during colonoscopy due to excess sputum production should be considered when making recommendations for pre-operative respiratory pulmonary examination.
- The patient's asthma is well-controlled on Breztri, as evidenced by fine PFT results and a negative CT chest scan 2, 3.
- The patient has a history of complications during colonoscopy, which may be related to their asthma or other respiratory issues 4.
- Studies have shown that budesonide-formoterol combination therapy can be effective in reducing asthma exacerbations and improving lung function 3, 5.
- As-needed use of albuterol-budesonide has been shown to result in a significantly lower risk of severe asthma exacerbation than as-needed use of albuterol alone among patients with mild asthma 6.
Recommendations for Pre-Operative Care
- Continue the patient's current Breztri treatment regimen to maintain well-controlled asthma.
- Monitor the patient's respiratory status closely before, during, and after the colonoscopy procedure.
- Consider administering a bronchodilator or other respiratory medication as needed to prevent bronchospasm or other respiratory complications during the procedure.
- Ensure that the patient's airway is secure and that they are able to breathe comfortably during the procedure.
- Have a plan in place for emergency situations, such as the availability of oxygen and other respiratory support equipment.