Güder Gülmisal, Rutten Frans H
Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
Curr Heart Fail Rep. 2014 Sep;11(3):337-46. doi: 10.1007/s11897-014-0212-x.
Heart failure and COPD are very common in the elderly. As both syndromes share common risk factors, such as tobacco smoking, and pathophysiological pathways, including systemic inflammation and activation of the neurohumoral system, they frequently coincide. Because of the similar clinical presentation, diagnoses of COPD in the presence of heart failure may be difficult. If spirometry is performed, caution should be taken in the interpretation of the data, as heart failure by itself (in the absence of true COPD) may exert restrictive as well as obstructive alterations in pulmonary function testing. Once COPD is established, concurrent heart failure may impact on the accurate management of these patients as severity grading of COPD could easily be overrated, and thus there is a risk of overuse of pulmonary medication, with the risk of causing cardiac side-effects. The present review focuses on the pathophysiological interrelation of comorbid COPD and heart failure, and provides practical help on how to deal with both diseases in daily practice.
心力衰竭和慢性阻塞性肺疾病（COPD）在老年人中非常常见。由于这两种综合征有共同的危险因素，如吸烟，以及共同的病理生理途径，包括全身炎症和神经体液系统激活，它们常常同时出现。由于临床表现相似，在存在心力衰竭的情况下诊断COPD可能会很困难。如果进行肺功能测定，在解读数据时应谨慎，因为心力衰竭本身（在没有真正的COPD时）可能在肺功能测试中导致限制性和阻塞性改变。一旦确诊COPD，并发的心力衰竭可能会影响这些患者的准确管理，因为COPD的严重程度分级可能很容易被高估，从而存在过度使用肺部药物的风险，并有可能引起心脏副作用。本综述重点关注合并COPD和心力衰竭的病理生理相互关系，并为日常实践中如何处理这两种疾病提供实际帮助。
