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Although predominantly a respiratory disease, it frequently has extra\u2010pulmonary manifestations and typically occurs in the context of other long\u2010term conditions. Patients experience a range of symptoms that affect their quality of life, functional ability and clinical outcomes. In this review, we discuss the evidence for techniques to optimise the care of people with chronic obstructive pulmonary disease in the peri\u2010operative period, and address potential new interventions to improve outcomes. The article centres on pulmonary rehabilitation, widely available for the treatment of stable chronic obstructive pulmonary disease, but less often used in a peri\u2010operative setting. Current evidence is largely at high risk of bias, however. Before surgery it is important to ensure that what have been called the \u2018five fundamentals\u2019 of chronic obstructive pulmonary disease treatment are achieved: smoking cessation; pulmonary rehabilitation; vaccination; self\u2010management; and identification and optimisation of co\u2010morbidities. Pharmacological treatment should also be optimised, and some patients may benefit from lung volume reduction surgery. Psychological and behavioural factors are important, but are currently poorly understood in the peri\u2010operative period. Considerations of the risk and benefits of delaying surgery to ensure the recommended measures are delivered depends on patient characteristics and the nature and urgency of the planned intervention.<\/jats:p>","DOI":"10.1111\/anae.15187","type":"journal-article","created":{"date-parts":[[2020,7,25]],"date-time":"2020-07-25T11:13:16Z","timestamp":1595675596000},"page":"681-694","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Pre\u2010operative optimisation for chronic obstructive pulmonary disease: a narrative review"],"prefix":"10.1111","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6068-2689","authenticated-orcid":false,"given":"A. H. 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