Coexistent Chronic Obstructive Pulmonary Disease-heart Failure: Mechanisms, Diagnostic and Therapeutic Dilemmas

摘要

Mortality in chronic obstructive pulmonary disease (COPD) is more often due to cardiac rather than respiratory causes.The coexistence of heart failure (HF) and COPD is frequent but remains under-diagnosed. Both conditions share severalsimilarities including the age of the population affected, a common risk factor in smoking and symptoms of exertionaldyspnoea. There is also a strong possibility of COPD promoting atherosclerotic vascular disease through systemicinflammation. Both the conditions are punctuated by episodes of acute exacerbations of symptoms from time to time wheredifferentiation between these two can be especially challenging. Although coexistence of the two is common, more often,only one of the two is diagnosed resulting in under-treatment and unsatisfactory response. Awareness of co-occurrenceis essential among both pulmonologists and cardiologists and a high index of suspicion should be maintained. Thecoexistence of the COPD and HF also poses several challenges in management. Active search for the second disease usingclinical examination supplemented with specialised investigations including plasma natriuretic peptides, lung function testingand echocardiography should be carried out followed by appropriate management. Issues such as adverse effects of drugson cardiac or pulmonary function need to be sorted out by studies in coexistent COPD-HF patients. Caution is advised withuse of a2-agonists in COPD when HF is also present, more so in acute exacerbations. On current evidence, the beneficialeffects of selective a1-blockers should not be denied in stable patients who have coexistent COPD-HF. The prognosis ofcoexistent COPD and HF is poorer than that in either disease alone. A favourable response in the patient with coexistentCOPD and HF depends on proper evaluation of the severity of each of the two and appropriate management with judicioususe of medication