Zhonghua Jie He He Hu Xi Za Zhi. 2022 Dec 12;45(12):1180-1191. doi: 10.3760/cma.j.cn112147-20220505-00380.
Patients with chronic obstructive pulmonary disease(COPD) often have co-existent systemic diseases(comorbidities), among which cardiovascular diseases (CVD) are the most common. The interactions between COPD and CVD are manifested in shared risk factors, disease severity, common symptoms, risks for exacerbations and disease progression, as well as therapeutic interventions. However, there is a knowledge gap in the management of COPD comorbidities. This expert consensus aims to increase the awareness, and to promote early diagnosis and proper management of cardiovascular comorbidities of COPD in medical professionals in China. The experts recommend that differential diagnosis should be performed for exertional dyspnea, a common symptom of COPD and cardiovascular diseases especially heart failure. Screening for cardiovascular diseases is needed in patients with COPD, and should be managed accordingly. COPD and comorbid CVD should be treated according to usual guidelines. Patients with COPD tolerate well to most of the medications for CVD. Selective β-blockers for cardiovascular diseases are not contraindicated in COPD, but should be initiated from lower doses, and symptoms of airflow limitation be monitored. Likewise, β-agonists and antimuscarinic drugs for COPD are generally safe for patients with comorbid CVD. Optimization of COPD management can improve heart function and cardiovascular outcomes.
慢性阻塞性肺疾病(COPD)患者常并存全身性疾病(合并症),其中心血管疾病(CVD)最为常见。COPD与CVD之间的相互作用体现在共同的危险因素、疾病严重程度、常见症状、急性加重和疾病进展风险以及治疗干预等方面。然而,在COPD合并症的管理方面存在知识空白。本专家共识旨在提高中国医疗专业人员对COPD心血管合并症的认识,促进早期诊断和合理管理。专家建议,对于COPD和心血管疾病尤其是心力衰竭的常见症状——劳力性呼吸困难,应进行鉴别诊断。COPD患者需要进行心血管疾病筛查,并应据此进行管理。COPD和合并的CVD应按照常规指南进行治疗。COPD患者对大多数心血管疾病药物耐受性良好。治疗心血管疾病的选择性β受体阻滞剂在COPD中并非禁忌,但应从小剂量开始使用,并监测气流受限症状。同样,用于COPD的β受体激动剂和抗胆碱能药物对合并CVD的患者通常是安全的。优化COPD管理可改善心脏功能和心血管结局。