Serviço de Medicina Interna, Hospital S. João, Porto, Portugal.
Curr Opin Pulm Med. 2010 Mar;16(2):106-11. doi: 10.1097/MCP.0b013e328335dc90.
Chronic obstructive pulmonary disease (COPD) and heart failure are prevalent comorbidities affecting a huge proportion of the world population, responsible for significant morbidity and mortality. Their coexistence is more frequent than previously recognized and poses important diagnostic and therapeutic challenges. Prognosis of patients with concurrent heart failure and COPD has not been comprehensively addressed. With this review, we intend to emphasize the diagnosis and prognosis implications of the two coexisting conditions and to highlight the therapeutic constraints posed by the combination.
Progressively, more attention has been given to the interplay between COPD and heart failure. The combination is frequent, but largely unrecognized due to overlapping clinical manifestations. Patients presenting with both conditions seem to have an ominous course. Despite the overwhelming evidence supporting cardioselective beta-blockade safety and tolerability in COPD patients, beta-blockers are underprescribed to heart failure patients with concomitant COPD.
COPD and heart failure coexistence is often overlooked. COPD diagnosis can remain unsuspected in heart failure patients due to similar symptoms. Although beta-blockers are well tolerated in COPD patients, they are overall less prescribed in this challenging population. COPD, at least at severe degrees of airflow obstruction, predicts a worse prognosis in heart failure patients.
慢性阻塞性肺疾病（COPD）和心力衰竭是常见的并存疾病，影响着世界上很大一部分人口，导致了相当高的发病率和死亡率。它们的共存比以前认识到的更为常见，带来了重要的诊断和治疗挑战。同时患有心力衰竭和 COPD 的患者的预后尚未得到全面评估。通过本次综述，我们旨在强调这两种并存疾病的诊断和预后意义，并强调组合治疗带来的限制。
越来越多的人关注 COPD 和心力衰竭之间的相互作用。这两种疾病同时存在的情况很常见，但由于临床表现重叠，很大程度上未被识别。同时患有这两种疾病的患者预后往往很凶险。尽管有大量证据支持选择性心脏β受体阻滞剂在 COPD 患者中的安全性和耐受性，但合并 COPD 的心力衰竭患者中β受体阻滞剂的处方量不足。
COPD 和心力衰竭并存的情况常常被忽视。由于症状相似，心力衰竭患者的 COPD 诊断可能未被怀疑。虽然 COPD 患者对β受体阻滞剂的耐受性良好，但在这一具有挑战性的人群中，β受体阻滞剂的总体处方量较少。至少在严重气流阻塞程度上，COPD 预示着心力衰竭患者的预后更差。
