Control of asthma for reducing the risk of bronchospasm in asthmatics undergoing general anesthesia and/or intravascular administration of radiographic contrast media

ABSTRACT

Background: It is well known that patients suffering from bronchial asthma undergoing surgical procedures requiring general anesthesia (GA) or the administration of water soluble radiographic contrast media (RCM) have an increased risk of potentially severe bronchospasm. Nevertheless, little attention has been devoted to the possible preventive measures to reduce the occurrence of this potentially life-threatening event.

It has been shown that the most important risk factor for bronchospasm during GA induction and/or the use of RCM is represented by a high degree of bronchial hyperreactivity with airway instability not adequately controlled by long-term anti-inflammatory treatment.

Aims: The aim of this commentary is to underline the need for an accurate clinical and functional evaluation of asthmatics undergoing surgical procedures requiring GA or radiological procedures requiring the administration of RCM, as well as to suggest a stepwise preventive pharmacological approach for reducing the risk of bronchospasm.

Methods: The authors’ suggestions represent clinical experience of the respiratory section of an internal hospital-based working group whose aim is the prevention of asthmatic/anaphylactic/anaphylactoid reactions during the administration of anesthetics and/or RCM.

The MEDLINE database was searched with a combination of keywords: general anesthesia, radio contrast media [and] bronchial asthma.

The main limitation of this commentary is the scarcity of available literature on this topic.

Findings: The authors suggest a therapeutic approach before surgical procedures requiring GA and/or RCM administration based on the degree of asthma control as assessed by clinical/functional criteria. In this setting, in addition to the necessity of obtaining the best control of airway reactivity, the authors suggest that an optimal control of asthma symptoms in ‘real life’ conditions might likely constitute a safety issue in asthmatic patients in the case of emergency procedures.

Abbreviations: GA (general anesthesia), RCM (radio contrast media), ACT (asthma control test), FEV₁ (forced expiratory volume in 1 second), FVC (forced vital capacity).

Key words: :

• Asthma control test (ACT)
• Bronchial asthma
• Bronchial hyperreactivity
• Bronchospasm
• General anesthesia
• Hypersensitivity
• Radio contrast media

Transparency

Declaration of funding

The publication of this article was sponsored by Menarini Italy. Menarini Italy has had no role in creating, writing or reviewing the article. The authors take full responsibility for all contents and views expressed in the manuscript.

Declaration of financial/other relationships

All the authors have disclosed that they have no relevant financial relationships.

All peer reviewers receive honoraria from CMRO for their review work. Peer Reviewer 1 has disclosed that he/she has no relevant financial relationships. Peer Reviewer 2 has disclosed that he/she has no relevant financial relationships.

Acknowledgments

The authors acknowledge Dr Marco Musella – Project Manager, Mediserve Communications srl, for assistance with the submissions process for this article. This assistance was funded by Menarini Italy.