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Obstructive airways disease in surgical practice.

Asthma and chronic obstructive pulmonary disease (COPD), i.e. chronic bronchitis and emphysema are common. The pathological and clinical features of these diseases are described. Ventilatory function, lung volumes and 6-min walking tests are used to assess respiratory function while blood gas estimations are essential when managing respiratory failure. The causal mechanisms of respiratory failure are described. In COPD careful assessment with maximization of respiratory function is essential preoperatively. Continued smoking increases postoperative complications sixfold. Bronchial irritability, common in asthma and COPD, increases the anaesthetic risks while many anaesthetic agents adversely affect respiratory function. Postoperative pulmonary complications remain common particularly in COPD. The hypoxia occurring in the first 2 hours post-surgery is usually more pronounced in COPD. Careful postoperative monitoring with aggressive treatment of any complications is essential in these patients. Surgical treatment may significantly improve respiratory function in some patients with bullous emphysema.