Heart failure, chronic obstructive pulmonary disease, and asthma: numbers, facts, and challenges

Heart failure (HF), chronic obstructive pulmonary disease (COPD), and asthma are considered as major health problems. They affect 1-3%, 4-10%, and 8-19% of population, respectively, and frequently coexist. Pulmonary function testing and echocardiography are needed for reliable diagnosis, but in clinical practice, diagnosis often is based on history and disease self-reporting. Concomitant HF can be diagnosed in about 20% of patients with COPD, and at least 50% had systolic dysfunction. In patients with HF, prevalence of COPD is up to 35%, and less than 25% of patients have COPD GOLD stage III or IV. COPD is more severe in patients with HF with preserved ejection fraction. When HF and COPD coexist, hazard of death is increased for 39% but can even exceed the mortality in individual disease by threefold. In patients with acute deterioration, natriuretic peptides and lung ultrasound, along with other laboratory biomarkers and imaging, need to be implemented to differentiate underlying cause and to manage patients accordingly. COPD is not contraindication for beta-blockers, and if used, the risk of death is reduced by 31%; if indicated, cardio-selective agents can be used in asthma. Recent pan-European registry reported that about 90% of patients with HF receive beta-blockers, whereas dosing remains a large unmet need with only 17% being treated with target daily dose. Concurrent HF and COPD reduce the prescription of beta blockers threefold, which results in about 20% of patients actually being treated with beta-blockers. In COPD/asthma, beta-agonists are strongly associated with new HF (relative risk of 3.41) and HF hospitalizations (odds ratio of 1.74).