Managing the heart failure patient with obstructive lung disease

Heart failure (HF) and obstructive lung disease (OLD) are chronic diseases associated with frequent emergency department visits and repeated hospitalizations and, when linked comorbidly, strongly associated with poor prognostic outcomes. When dyspnea occurs in a HF patient with OLD, the practitioner is challenged to determine which disease exacerbation underlies the current symptom. The purpose of this article is to provide the HF practitioner with practical information about how to make these distinctions and how to develop a treatment plan for the HF patient that incorporates important information about OLD. The pathophysiology of OLD and HF is reviewed first, followed by details on the assessment of dyspnea and the management of acute exacerbations of OLD. Finally, pharmacologic issues in the management of concomitant HF and OLD are reviewed.