COPD in chronic heart failure: Less common than previously thought?

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• 作者：Armine G. Minasian ; Frank J.J. van den Elshout ; P.N. Richard Dekhuijzen ; Petra J.E. Vos ; Frank F. Willems ; Paul J.P.C. van den Bergh ; Yvonne F. Heijdra
• 关键词：Chronic heart failure ; Chronic obstructive pulmonary disease ; Prevalence ; Fixed ratio ; Lower limit of normal
• 刊名：Heart Lung: The Journal of Acute and Critical Care
• 出版年：2013
• 出版时间：September-October, 2013
• 年：2013
• 卷：42
• 期：5
• 页码：365-371
• 全文大小：260 K

文摘

Background

Using a fixed ratio of forced expiratory volume in 1?s to forced vital capacity (FEV₁/FVC)?<?0.70 instead of the lower limit of normal (LLN) to define chronic obstructive pulmonary disease (COPD) may lead to overdiagnosis of COPD in elderly patients with heart failure (HF) and consequently unnecessary treatment with possible adverse health effects.

Objective

The aim of this study was to determine COPD prevalence in patients with chronic HF according to two definitions of airflow obstruction.

Methods

Spirometry was performed in 187 outpatients with stable chronic HF without pulmonary congestion who had a left ventricular ejection fraction <40 % (mean age 69?¡À?10 years, 78 % men). COPD diagnosis was confirmed 3 months after standard treatment with tiotropium in newly diagnosed COPD patients.

Results

COPD prevalence varied substantially between 19.8 % (LLN-COPD) and 32.1 % (GOLD-COPD). Twenty-three of 60 patients (38.3 % ) with GOLD-COPD were potentially misclassified as having COPD (FEV₁/FVC?<?0.7 but?>?LLN). In contrast to patients with LLN-COPD, potentially misclassified patients did not differ significantly from those without COPD regarding respiratory symptoms and risk factors for?COPD.

Conclusions

One fifth, rather than one third, of the patients with chronic HF had concomitant COPD using the LLN instead of the fixed ratio. LLN may identify clinically more important COPD than a fixed ratio of?0.7.