Chronic obstructive airway disease is usually due to chronic bronchitis, in which viscous mucus accumulates in the airways. A chronic cough is usually present, and the inability to clear the mucus from the lung structures results in frequent secondary infections and may be associated with emphysema. This type of lung disorder is nearly always associated with chronic hypoxia. Patients with more severe disease cannot tolerate lengthy procedures and are extremely uncomfortable if treated supine. Surgical procedures that can be reasonably completed in about 20–30 minutes under local anesthesia may be undertaken in the general practice environment with the patient sitting, not supine. Intravenous sedation should be used only with carefully selected patients because, once the patient is reclined and reduced respiratory function from the disease will cause difficulties in breathing, which are exacerbated by sedation. The use of supplementary oxygen during sedation is helpful, but the patient must be monitored carefully and continuously. Asthma is common; it is valuable to assess the severity of the disease before planning treatment. Patients who have been hospitalized with an episode of asthma or who take systemic steroids on a regular basis should be considered as severe asthmatics and unsuitable for sedation or general anesthesia, except in hospital. Patients suffering from milder asthma, which is controlled with inhalers, are usually suitable for management in general practice. An asthma attack can be precipitated by stress, so it is important to plan treatment in a sympathetic way to avoid anxiety from undue waiting before surgery and, where necessary, to use premedication. Treatment under local anaesthesia is usually safe; patients should have with them their usual medications and use their inhaler before treatment.
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