Secretions – Consider an antimuscarinic (eg Robinul) to reduce anticipated secretions. Have a suction catheter handy and anticipate using as needed throughout the case.

Double Lumen Tube – absolutely necessary in cases where the surgery is for hemoptysis or an empyema. Purulent sputum can and will migrate to other areas of the lung if this is not applied.

Avoid Nasal Intubation – Chronic sinusitis is common in these patients.

Cancellation – if the patient is demonstrating an active pulmonary infection leading to respiratory compromise or systemic involvement, elective cases should be delayed until the patient is optimized.

Medications – patient should continue taking medications used to control this condition until the morning of surgery.

Hx – get a detailed history of what worsens symptoms, how often the patient requires inhalers, recent exacerbations etc.

Irreversible obstructive respiratory disease – The bronchi have been dilated and damaged due to inflammatory processes. This is often caused by infections.

Susceptible to pulmonary infection – at a certain point, these patients become especially susceptible to pulmonary infections. This is due to mucociliary damage and accumulation of mucus in dilated airways.

Symptoms – include a productive cough, purulent sputum, chest or pleuritic pain, and in some cases, severe hemoptysis. Later in the disease process, clubbed fingers may be seen. CT scans will show dilated bronchi.

Treatment – prophylactic antibiotics, flu shots, etc are all common to prevent diseases that would worsen/exacerbate the condition. Chest physiotherapy, oxygen, bronchodilators, and corticosteroids are all common treatments depending on the disease severity.