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


OBJECTIVE
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.


RESULTS
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.
Liccardi
Gennaro
G
Department of Chest Diseases, Division of Pneumology and Allergology, A. Cardarelli High Speciality Hospital, Naples, Italy. gennaro.liccardi@tin.it
Salzillo
Antonello
A
De Blasio
Francesco
F
D'Amato
Gennaro
G
D000309:Adrenal Insufficiency / Q000517:prevention & control; D000465:Algorithms; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D001249:Asthma / Q000000981:diagnostic imaging* / Q000628:therapy*; D001986:Bronchial Spasm / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D006287:Health Planning Guidelines; D006801:Humans; D007275:Injections, Intravenous; D008954:Models, Biological; D011300:Preoperative Care / Q000379:methods; D015995:Prevalence; D011859:Radiography; D012307:Risk Factors; D040242:Risk Reduction Behavior
D003287:Contrast Media