Perioperative Management of Patients with Asthma-COPD Overlap Syndrome - Where Do We Stand? A Case Report-Based Discussion

Background: Postoperative pulmonary complications (PPCs) are associated with a significant morbidity and mortality; prevention and management strategies depend greatly on the patients’ comorbid conditions. Chronic Obstructive Pulmonary Disease (COPD) is a well-known risk factor for PPCs, but controlled Asthma does not appear to be so. On the other hand, the role of Asthma-COPD Overlap Syndrome (ACOS) as a risk for PPCs is yet to be studied. While there is a guidance for the perioperative risk reduction and management of COPD and Asthma, specific guidance for ACOS is also lacking. As a consequence, physicians tailor their management by considering both the components. Case presentation: We present a case of a 74-year-old man with ACOS, diagnosed with invasive bladder carcinoma. He was taken for laparoscopic radical cystectomy and ileal conduit. Although he had an uneventful surgery, we lost him on the seventh postoperative day due to multiple complications, including PPCs.  Conclusion: The case highlights the need for considering the ACOS separately as a risk and calls for a specific roadmap for perioperative management.   Asthma-COPD Overlap Syndrome patients appear to be at high risk of PPCs There is a lack of evidence-based guidance and literature to tailor the management of such patients to reduce the perioperative risks for PPCs It is high time to delineate the ACOS patients from Asthma and COPD, study them in context to PPCs and perioperative outcome so that specific guidance can be developed.