It is fairly common for COPD patients to need major surgery at some point. A significant number of them have developed lung cancer, as it shares COPDs and cardiovascular disease's kinship to smoking. A number of other conditions typically associated with advancing age also require surgery.

It used to be that COPD and surgery were a very lethal combination. But light years of progress have been made in the decades since the 1950s and 1960s: improved surgical techniques, commonplace forms of breathing support and cardiac monitoring that weren't even available then, plus pharmacology advances. So surgery itself is far more effective, and pre-and postoperative care of critically ill patients has vastly improved. That is why there are patients with serious pulmonary disease now undergoing surgery much more frequentlyand much more safely.

When a COPD patient develops a condition requiring surgical treatment, his doctor has to weigh the benefits of surgery against the complications it might provoke. In assessing the nature and likelihood of risk, his doctor must consider what is known about the particular procedure's impact on COPD, and try to estimate the chance of pulmonary complicationspossibly leading to deathfollowing surgery. But there is often precious little to guide him in this estimation.

Only one surgical procedure is permittedbased on a pulmonary function testto predict reasonably well how a COPD patient will do after surgery. That involves removal of lung tissue, most typically for lung cancer. Other than that, they have to evaluate each patient as he appears to themand reality can contradict their perceptions. Doctors have learned, for example, that such high-impact procedures as open heart surgery can be survived by severely ill patients who seemed, by all measures, to be very poor risks.

The difficulty in predicting the risk an individual patient actually faces means that doctors who treat advanced COPD patients often face a knotty decision: Should potentially lifesaving surgery be withheldor notwhen the risk of postsurgical pulmonary complications seems high enough to cancel the benefits?

A major comfort, when contemplating surgery, is that more and more doctors are learning to avoidor at least minimizepostoperative complications by recognizing the severity of a patient's COPD, then taking appropriate preventive steps before, during, and after surgery. We note these steps below.

Before Surgery

One of the most important presurgical issues is which hospital to choose. Our advice is to choose one that does a high volume of the procedure you need. It's been shown time and again that the number and severity of complications following a particular surgical procedure go up as the experience of both surgical and nursing staff go down. With more procedures, the postoperative course is substantially smoother and any complications that do arise are far more effectively controlled.

Next is having a good preoperative plan, to minimize your obvious vulnerability to pulmonary complications. The general aim of the plan is maximizing your physical condition. And it helps substantially. Research indicates, for example, that proper preoperative care can reduce the postsurgical occurrence of pneumonia by 60%.

Although the details of your presurgical program would depend on the severity of your lung disease, the basic components apply to any COPD patient.

Stop smoking, if you haven't done it yet. Have your sputum checked, with appropriate antibacterial medication if there is any sign of infection.

Open and clear your airways as much as possible. For starters, fine-tune bronchodilator therapy to optimize airway relaxation and high mucus clearance. A short steroid course to reduce airway inflammation should be considered. Do more frequent chest percussion and postural drainage. Try warm water in aerosol form several times a day to help loosen tenacious sputum for optimal results.

Education. If you haven't yet learned the breathing exercises and how to cough effectively (called huffing), learn and practice them now. Also practice breathing with an incentive spirometer to help deepen your breaths. This will all help prevent your air sacs from collapsing (called atelectasis) after surgery.

Learn the simple foot exercises and knee flexion movements that should be done several times an hour after surgery. This is very important in preventing blood clots.