Heart failure and chronic obstructive pulmonary disease: Two for tea or tea for two?

Abstract

A combination of chronic obstructive pulmonary disease (COPD) and heart failure (HF) is common yet it is inadequately and rarely recognized. Because of the similar clinical manifestations, comorbidity is frequently not considered and appropriate diagnostic tests are not performed. It is very important that a combination of COPD and HF is recognized as these patients have a worse prognosis than patients with an individual disease. When present, COPD should not prevent the use of life-saving therapy in patients with HF, particularly β-blockers. Despite clear evidence of the safety and tolerability of cardioselective β-blockers in COPD patients, these drugs remain grossly underprescribed and underdosed. Routine spirometry and echocardiography in HF and COPD patients, respectively, is therefore warranted to improve current clinical practice.

Cardiac biomarkers predict outcome after hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease

“…As cardiovascular disease is more accessible to treatment modalities that improve outcome, such evaluation could have important clinical impact for patients and the health care system. A collaborative approach between pulmonologists and cardiologists, as already alluded to in past [31,32], and suggested by competent scientific authorities [1,16] needs to be promoted and implemented.…”

Heart failure, chronic obstructive pulmonary disease, and asthma: numbers, facts, and challenges

“…COPD has several effects on respiratory and cardiovascular systems that may limit optimal cardiac imaging, particularly during the transthoracic echocardiography. Poor visibility because of lung hyperinflation, ventricular interdependence, atrial fibrillation are some of the challenges for echocardiography interpretation …”

“…Poor visibility because of lung hyperinflation, ventricular interdependence, atrial fibrillation are some of the challenges for echocardiography interpretation. 6,7 In patients with definitive diagnosis of COPD and HF, several therapeutic challenges exist. Over the recent years, fear of betablockers seems to fade away; whilst this is true for treatment initiation, many patients remain undertreated.…”

“…In fact, about half of patients in the community remain undiagnosed, and for those with diagnosis, more than half is left with symptomatic relief only . As diseases share risk factors, they frequently walk hand‐in‐hand; because of similarities in clinical presentation, accurate diagnosis, particularly during acute decompensation is challenging and initial treatment may be targeting wrong organs . Even when stable, HF may alter pulmonary function findings or COPD may limit cardiac imaging to a degree when reliable diagnosis is doubtful.…”

“…5 As diseases share risk factors, they frequently walk hand-in-hand; because of similarities in clinical presentation, accurate diagnosis, particularly during acute decompensation is challenging and initial treatment may be targeting wrong organs. 6 Even when stable, HF may alter pulmonary function findings or COPD may limit cardiac imaging to a degree when reliable diagnosis is doubtful. Similar apply to natriuretic peptides as we need to acknowledge concentrations can be elevated because of right ventricular overload only.…”