Answer:

The increasing understanding of the inflammatory component of reactive airway disease has led to greater appreciation of the importance of steroids in preventing and treating exacerbations. In wheezing patients, oral methylprednisolone 40 mg daily for 5 days before surgery has been shown to decrease postintubation bronchospasm. The oft-cited concern that steroids increase the rate of wound complications is not well founded. A study of patients with asthma treated with steroids preoperatively found no increase in the incidence of wound infections or wound-healing problems.

Patients with poorly controlled asthma presenting for surgery with high risk of PPCs (open aortic aneurysm repair, thoracic, upper abdominal) that will require endotracheal intubation must be treated with utmost caution, and may benefit from preoperative optimization of pulmonary function with a short course of systemic steroids. On the other hand, patients with mild, well-controlled disease should not require such treatment.

• Bishop MJ. Preoperative corticosteroids for reactive airway?Anesthesiology. 2004;100:1047-1048.
• Hines RL, Marschall KE, eds. Stoelting’s Anesthesia and Co-existing Disease. 7th ed. Philadelphia, PA: Elsevier; 2018:20-22.
• Silvanus M-T, Groeben H, Peters J. Corticosteroids and inhaled salbutamol in patients with reversible airway obstruction markedly decrease the incidence of bronchospasm after tracheal intubation. Anesthesiology. 2004;100:1052-1057.
• Woods BD, Sladen RN. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth. 2009;103(suppl 1):i57-i65.