Padeletti Margherita, Jelic Sanja, LeJemtel Thierry H
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States.
Int J Cardiol. 2008 Apr 10;125(2):209-15. doi: 10.1016/j.ijcard.2007.12.001. Epub 2008 Jan 24.
The prevalence of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) increases substantially with age. The coexistence of COPD and CHF is common but often unrecognized in elderly patients. To avoid overlooking COPD in elderly patients with known CHF pulmonary function tests should be routinely obtained. Likewise, to avoid overlooking CHF in elderly patients with known COPD left ventricular (LV) function should be routinely assessed. Plasma brain natriuretic peptide levels are useful to differentiate COPD exacerbation from CHF decompensation in patients presenting with acute dyspnea. Aging exacerbates skeletal muscle alterations that occur in patients with CHF and COPD. Skeletal muscle metabolic alterations and atrophy and the resulting deterioration of functional capacity progress rapidly in elderly patients with COPD and CHF. Physical conditioning reverses rapidly progressing skeletal muscle metabolic alterations and atrophy and promotes independence and life quality in the elderly. Physical conditioning is clearly an essential component of the management of elderly patients with COPD and CHF. The pharmacological management of patients with coexistent COPD and CHF should focus on not depriving these patients from long-term beta adrenergic blockade. Long-term beta adrenergic blockade has been repeatedly shown to improve survival in elderly patients with CHF due to LV systolic dysfunction and, contrary to conventional belief, is well tolerated by patients with COPD.
慢性阻塞性肺疾病（COPD）和慢性心力衰竭（CHF）的患病率随年龄大幅增加。COPD和CHF并存很常见，但在老年患者中往往未被认识到。为避免在已知患有CHF的老年患者中漏诊COPD，应常规进行肺功能检查。同样，为避免在已知患有COPD的老年患者中漏诊CHF，应常规评估左心室（LV）功能。血浆脑钠肽水平有助于鉴别急性呼吸困难患者的COPD加重与CHF失代偿。衰老会加剧CHF和COPD患者出现的骨骼肌改变。在患有COPD和CHF的老年患者中，骨骼肌代谢改变、萎缩以及由此导致的功能能力下降进展迅速。体能锻炼可逆转迅速进展的骨骼肌代谢改变和萎缩，并促进老年人的独立性和生活质量。体能锻炼显然是老年COPD和CHF患者管理的重要组成部分。COPD和CHF并存患者的药物治疗应注重不剥夺这些患者长期使用β肾上腺素能阻滞剂的机会。长期β肾上腺素能阻滞剂已多次被证明可提高因LV收缩功能障碍导致CHF的老年患者的生存率，而且与传统观念相反，COPD患者对其耐受性良好。
