脳神経外科診療で遭遇する慢性呼吸器疾患

Clinical Management of Respiratory Diseases in Neurosurgical Settings

Point

・本邦は超高齢社会を迎えており，慢性呼吸器疾患は増加傾向にあり，日常診療で遭遇する機会が増えてきている．

・慢性閉塞性肺疾患（COPD）と気管支喘息はcommon diseaseであり，成人の2割近くがいずれかの疾患に罹患している可能性があり，周術期合併症を減らすためにも両疾患の病態の理解と適切なマネジメントが必要である．

・本稿では，COPDと気管支喘息の病態や治療，周術期に注意すべき事項について解説する．

　Respiratory diseases, such as chronic obstructive pulmonary disease（COPD）and asthma, are becoming increasingly prevalent in super-aging societies. In Japan, the estimated prevalence of COPD among individuals aged 40 years and above is 8.6%, while asthma affects about 10% of adults. These statistics highlight the similarities between COPD and asthma in clinical settings. Both diseases involve chronic airway inflammation and present with symptoms such as chronic cough, sputum production, wheezing, and dyspnea. Exacerbations of these symptoms and complications are critical concerns during the perioperative period. COPD, often caused by long-term smoking, leads to irreversible airway and lung damage, while asthma is characterized by episodic and reversible airway constriction due to chronic inflammation. COPD diagnosis involves spirometry and the exclusion of other diseases, with treatment goals focusing on symptom improvement and risk reduction through smoking cessation, pharmacotherapy（mainly bronchodilators）, and non-pharmacological methods（such as pulmonary rehabilitation）. Asthma management aims to control inflammation and prevent exacerbations using inhaled corticosteroids and bronchodilators as standard treatments. Perioperative management of both diseases involves improving respiratory function with pharmacotherapy, careful anesthesia selection, and early postoperative mobilization. Consultation with respiratory specialists is recommended for effective management, especially in complex cases.