| Popis: |
Approximately one in four patients with heart failure (HF) has a clinical diagnosis of pulmonary disease, predominantly chronic obstructive pulmonary disease (COPD). A further 40–70% may have unrecognized airflow obstruction. Clinical diagnosis is challenging given the cardinal symptom of both conditions is dyspnoea. Objective documentation of airflow obstruction by pulmonary function tests is essential, performed during clinical stability to avoid obstruction associated with congestion. In patients with pulmonary disease, natriuretic peptides retain high negative predictive values for excluding heart failure. The treatment of both HF and COPD should not deviate from international guidelines. The risk of bronchoconstriction due to beta blockers, and adverse cardiovascular events attributable to bronchodilators is controversial. The balance of evidence strongly favours prescribing beta blockers irrespective of pulmonary disease, recommending caution only in very severe COPD. Similarly, bronchodilators exhibit a reassuring safety profile, particularly long-acting muscarinic antagonists. Caution is advised when commencing new bronchodilator therapy, using high-dose, short-acting compounds, or when treating patients with severe heart failure. Concurrent pulmonary disease in patients with HF further impairs symptoms, quality of life, and exercise capacity. It also increases the risk of HF hospitalization, non-cardiovascular adverse outcomes, and long-term mortality. All efforts should be made to correctly identify and treat lung disease in clinical practice. |
