COPD in chronic heart failure: Less common than previously thought?

• Published in: Heart & lung Vol. 42; no. 5; pp. 365 - 371
• Main Authors: Minasian, Armine G., MD, PhD(c), van den Elshout, Frank J.J., MD, PhD, Dekhuijzen, P.N. Richard, MD, PhD, Vos, Petra J.E., MD, PhD, Willems, Frank F., MD, PhD, van den Bergh, Paul J.P.C., MD, Heijdra, Yvonne F., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.09.2013; Elsevier Science Ltd
• Subjects: Aged; Aged, 80 and over; Cardiovascular; Chronic Disease; Chronic heart failure; Chronic obstructive pulmonary disease; Cohort Studies; Critical Care; Female; Fixed ratio; Forced Expiratory Volume; Heart failure; Heart Failure - complications; Humans; Lower limit of normal; Male; Medical treatment; Middle Aged; Older people; Prevalence; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary/Respiratory; Risk Factors; Spirometry; Vital Capacity; NT-pro-BNP; Prevalence; LVEF; modified Medical Research Council dyspnea scale; PY; angiotensin receptor blocker; Chronic heart failure; Lower limit of normal; left ventricular ejection fraction; FEV 1/FVC; current smokers; New York Heart Association; percutaneous coronary intervention; Chronic obstructive pulmonary disease; N-terminal pro-B natriuretic peptide; coronary artery bypass grafting; PFT; NYHA; heart failure; pack-years; non-smokers; cardiac resynchronization therapy; body mass index; Fixed ratio; ARB; ratio of forced expiratory volume in 1 s to forced vital capacity; angiotensin-converting enzyme inhibitor; PCI; CABG; former smokers; MRC; GOLD; ATS/ERS; CRT; NS; American Thoracic Society/European Respiratory Society; Global Initiative for Chronic Obstructive Lung Disease; FS; LLN; aspecific bronchial hyperreactivity; pulmonary function tests; BMI; Minnesota Living with Heart Failure Questionnaire; ICD; ACE-I; left ventricular systolic dysfunction; CS; implantable cardioverter defibrillator; MLHFQ; ABHR; LVSD; HF; COPD; FEV1/FVC; FEV/FVC
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2013.07.002

Abstract Background Using a fixed ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1 /FVC) < 0.70 instead of the lower limit of normal (LLN) to define chronic obstructive pulmonary disease (COPD) may lead to overdiagnosis of COPD in elderly patients with heart failure (HF) and consequently unnecessary treatment with possible adverse health effects. Objective The aim of this study was to determine COPD prevalence in patients with chronic HF according to two definitions of airflow obstruction. Methods Spirometry was performed in 187 outpatients with stable chronic HF without pulmonary congestion who had a left ventricular ejection fraction <40% (mean age 69 ± 10 years, 78% men). COPD diagnosis was confirmed 3 months after standard treatment with tiotropium in newly diagnosed COPD patients. Results COPD prevalence varied substantially between 19.8% (LLN-COPD) and 32.1% (GOLD-COPD). Twenty-three of 60 patients (38.3%) with GOLD-COPD were potentially misclassified as having COPD (FEV1 /FVC < 0.7 but > LLN). In contrast to patients with LLN-COPD, potentially misclassified patients did not differ significantly from those without COPD regarding respiratory symptoms and risk factors for COPD. Conclusions One fifth, rather than one third, of the patients with chronic HF had concomitant COPD using the LLN instead of the fixed ratio. LLN may identify clinically more important COPD than a fixed ratio of 0.7.