The restrictive–obstructive continuum and the failing heart

Engström, Gunnar

doi:10.1136/thoraxjnl-2015-208119

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…In addition, cubic spline graphs suggested inverse dose–response relationships of FEV 1% predicted and FEV 1 /FVC with VTE. COPD is characterized by reduced FEV 1 /FVC . Thus, these results support the hypothesis that COPD may increase the risk of VTE.…”

Section: Discussionsupporting

confidence: 81%

Lung function, respiratory symptoms and venous thromboembolism risk: the Atherosclerosis Risk in Communities Study

Kubota

London

Cushman

et al. 2016

Journal of Thrombosis and Haemostasis

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Summary Background The evidence of the association between chronic obstructive pulmonary disease (COPD) and venous thromboembolism (VTE) is limited. There is no study investigating the association of restrictive lung disease (RLD) and respiratory symptoms with VTE. Objectives To investigate prospectively the association of lung function and respiratory symptoms with VTE. Patients/Methods In 1987–1989, we assessed lung function using spirometry and obtained information on respiratory symptoms (cough, phlegm and dyspnea) in 14 654 participants aged 45–64, without a history of VTE or anticoagulant use, and followed them through 2,011. Participants were classified into four mutually exclusive groups, ‘COPD’ [forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC)

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Section: Discussionsupporting

confidence: 81%

Lung function, respiratory symptoms and venous thromboembolism risk: the Atherosclerosis Risk in Communities Study

Kubota

London

Cushman

et al. 2016

Journal of Thrombosis and Haemostasis

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“…However, permanent damage to the alveolar‐capillary membrane might be present in patients with chronic ‘dry lung HF’ and determine a reduction in D LCO , which is independent of pulmonary congestion, and/or COPD . In addition, because ‘wet lung HF’ may present a mixed obstructive/restrictive spirometric pattern, determination of the coexistence or the severity of COPD should wait until HF is optimally treated . The scenario might be finally further complicated by the presence of associated cardiac conditions, such as atrial fibrillation, pulmonary hypertension and right ventricular strain and failure, which might independently increase natriuretic peptide levels …”

Section: Pulmonary Function Testing In Heart Failurementioning

confidence: 99%

What can we learn from pulmonary function testing in heart failure?

Magnussen

Canepa

Zambito

et al. 2017

European J of Heart Fail

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Pulmonary diseases frequently coexist in heart failure (HF), thus posing diagnostic and therapeutic challenges to cardiologists evaluating patients with overlapping symptoms and implementing recommended HF treatments. There is a growing body of evidence suggesting that pulmonary function testing might provide useful information for the best management of these patients. The availability of portable devices, allowing the measurement of spirometry and lung diffusion capacity for carbon monoxide outside of hospital-based pulmonary lung function laboratories, provides an opportunity for a more widespread use of these measures in the cardiology community, but their interpretation can be challenging. In this work, after a brief review of the methodologies, we discuss the interpretation of pulmonary function testing in patients with HF alone or associated with pulmonary diseases, and its contribution in differentiating cardiac and pulmonary symptoms and preventing acute cardiac decompensation. In addition, we examined recent evidence suggesting how the use of pulmonary function testing may provide independent prognostic information in HF patients with and without pulmonary disorders, and help therapeutic decisions to fill the treatment gap that still exists in HF patients with concomitant pulmonary diseases.

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“…A possible explanation for the underuse of spirometry in patients with HF who have symptoms of COPD is that spirometry is not easily accessible to cardiologists and the fact that the cardiology community shows some skepticism towards the discriminatory capacity of spirometry in patients with HF [ 72 ]; accordingly, the prevalence of COPD is notably lower in patients managed by cardiologists as opposed to general physicians [ 150 , 151 , 152 , 153 ]. The interpretation of spirometry results during acute decompensation in patients with HF can be challenging because “wet lung HF” may present with airway restriction or obstruction [ 62 ], so the current guidelines of both the European Society of Cardiology [ 154 ] and the GOLD group [ 11 , 90 ] recommend that spirometry is performed when HF conditions are stable [ 62 , 75 , 148 , 155 ]. However, timely referral and following up to the pulmonologist or respiratory clinic, or alternatively the use of spirometry in cardiac clinics, needs to be implemented because its scarce use leads to about 30% of patients with chronic HF being mislabeled with COPD without confirmation of airflow obstruction, and a similar proportion of patients have unrecognized airflow obstruction [ 156 ].…”

Section: Hospital Stay: Definitive Diagnosismentioning

confidence: 99%

Implementation of the Care Bundle for the Management of Chronic Obstructive Pulmonary Disease with/without Heart Failure

Bianco,

Canepa,

Catapano

et al. 2024

JCM

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Chronic obstructive pulmonary disease (COPD) is often part of a more complex cardiopulmonary disease, especially in older patients. The differential diagnosis of the acute exacerbation of COPD and/or heart failure (HF) in emergency settings is challenging due to their frequent coexistence and symptom overlap. Both conditions have a detrimental impact on each other’s prognosis, leading to increased mortality rates. The timely diagnosis and treatment of COPD and coexisting factors like left ventricular overload or HF in inpatient and outpatient care can improve prognosis, quality of life, and long-term outcomes, helping to avoid exacerbations and hospitalization, which increase future exacerbation risk. This work aims to address existing gaps, providing management recommendations for COPD with/without HF, particularly when both conditions coexist. During virtual meetings, a panel of experts (the authors) discussed and reached a consensus on the differential and paired diagnosis of COPD and HF, providing suggestions for risk stratification, accurate diagnosis, and appropriate therapy for inpatients and outpatients. They emphasize that when COPD and HF are concomitant, both conditions should receive adequate treatment and that recommended HF treatments are not contraindicated in COPD and have favorable effects. Accurate diagnosis and therapy is crucial for effective treatment, reducing hospital readmissions and associated costs. The management considerations discussed in this study can potentially be extended to address other cardiopulmonary challenges frequently encountered by COPD patients.

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The restrictive–obstructive continuum and the failing heart

Cited by 5 publications

References 15 publications

Lung function, respiratory symptoms and venous thromboembolism risk: the Atherosclerosis Risk in Communities Study

Lung function, respiratory symptoms and venous thromboembolism risk: the Atherosclerosis Risk in Communities Study

What can we learn from pulmonary function testing in heart failure?

Implementation of the Care Bundle for the Management of Chronic Obstructive Pulmonary Disease with/without Heart Failure

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