Department of Respiratory Diseases, Azienda Ospedaliero Universitaria, Sassari, Italy.
General Practitioner, Carbonia, Italy.
Respir Med. 2017 Oct;131:1-5. doi: 10.1016/j.rmed.2017.07.059. Epub 2017 Jul 25.
COPD frequently coexists with HF with which shares several risk factors. A greater collaboration is required between cardiologists and pulmonologists to better identify and manage concurrent HF and COPD. This observational, retrospective study provides new data regarding the management of these patients.
from the Health Search Database which collects information generated by the routine activity of general practitioners, we selected 803 patients suffering from COPD or HF alone or combined analyzing similarities and differences regarding risk factors, diagnostic workup and therapeutic approaches.
Statistical analyses have evidenced significant differences regarding exposure to cigarette smoke and the prevalence of diabetes and hypertension in the three groups of patients. As regard to the diagnostic workup, it has been found that the 63,9% of COPD patients and the 57,1% of COPD + HF patients performed a spirometry vs the 95,4% of HF patients and the 95,2% of COPD + HF patients that performed an ECG. Regarding the pharmacologic treatment, the 47% of COPD patients was treated with an ICS/LABA association and the 22% with ICS/LABA + LAMA. In the COPD + HF group, 47% of patients were treated with ICS/LABA association, while 32% of these patients were treated with ICS/LABA + LAMA. The pharmacologic treatment most prescribed in HF was β-blockers (68%), diuretics (92.8%), antiplatelet therapy (55.6%) and ACE inhibitors (38.1%). In the COPD + HF group, β-blockers (40.1%), diuretics (89.8%), antiplatelet therapy (57.1%) and ACE inhibitors (44.9%) were prescribed.
this study has evidenced a disparity in performing instrumental diagnosis between COPD and HF groups that persists when both conditions coexist. Moreover, the pharmacological treatment of the two conditions shows a consistent under treatment with bronchodilators in COPD patients and with β-blockers in HF patients.
COPD 常与 HF 共存，两者有一些共同的危险因素。心脏病专家和肺病专家需要更密切地合作，以更好地识别和管理同时存在的 HF 和 COPD。这项观察性、回顾性研究提供了关于这些患者管理的新数据。
我们从 Health Search 数据库中选择了 803 名患有 COPD 或 HF 或两者同时存在的患者的信息，这些患者的信息来自全科医生的日常活动。我们分析了这三组患者在危险因素、诊断评估和治疗方法方面的相似和不同之处。
统计学分析表明，三组患者在接触香烟烟雾和糖尿病和高血压的患病率方面存在显著差异。在诊断评估方面，我们发现 63.9%的 COPD 患者和 57.1%的 COPD+HF 患者进行了肺功能检查，而 95.4%的 HF 患者和 95.2%的 COPD+HF 患者进行了心电图检查。在药物治疗方面，47%的 COPD 患者接受了 ICS/LABA 联合治疗，22%的患者接受了 ICS/LABA+LAMA 治疗。在 COPD+HF 组中，47%的患者接受了 ICS/LABA 联合治疗，而其中 32%的患者接受了 ICS/LABA+LAMA 治疗。HF 患者最常开的药物是β受体阻滞剂（68%）、利尿剂（92.8%）、抗血小板治疗（55.6%）和 ACE 抑制剂（38.1%）。在 COPD+HF 组中，β受体阻滞剂（40.1%）、利尿剂（89.8%）、抗血小板治疗（57.1%）和 ACE 抑制剂（44.9%）被开处方。
这项研究表明，在 COPD 和 HF 两组之间，进行仪器诊断的差异仍然存在，当两种疾病同时存在时更是如此。此外，两种疾病的药物治疗都显示出一致的治疗不足，在 COPD 患者中使用支气管扩张剂治疗不足，在 HF 患者中使用β受体阻滞剂治疗不足。
