322 Preoperative Cardiopulmonary Exercise Testing (CPET) in Severe Asthma Patients

BACKGROUND: Lung resection is still the only potentially curative therapy for patients with localised non-small lung cancer (NSCLC). However, the presence of cardiovascular comorbities and pulmonary function impairment increase the risk of perioperative death and postoperative complications. Various studies have evaluated the use of different preoperative tests aiming to identify asthma patients at greater risk for complications. METHODS: A literature search was performed in Pubmed to identify relative studies published until June 2011. RESULTS: Postoperative complications are associated with prolonged hospital stays and excessive morbidity and mortality especially in this group of patients. According to the ACCP/BTS guidelines, patients without known underlying lung disease with a preoperative FEV1 in excess of 2 L, generally tolerate pneumonectomy whereas those with FEV1 greater that 1.5 L, tolerate lobectomy. Although spirometric values strongly correlate with the severity of obstruction, they do not provide direct information regarding the degree of gas exchange impairment or the status of cardiovascular function. Cardiopulmonary exercise testing (CPET) is a preoperative test suggested before lung resection in patients with known underlying cardiovascular or lung disease. It is based on the interactions among pulmonary function, cardiovascular function and oxygen absorption from the peripheral tissues. Patients with maximal oxygen consumption (VO(2) max) <10 mL/kg/min or those with VO(2) max < 15 mL/kg/min and both postoperative predicted FEV1 and DLCO <40% are considered to be at high risk of perioperative death and cardiopulmonary complications postoperatively. Studies have shown that oxygen uptake efficiency slope, oxygen pulse and heart rate at peak exercise are correlated with better postoperative outcome. CONCLUSIONS: Further research is required to elucidate the role of CPET in the preoperative evaluation of this group of patients.