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Clinical and Physiologic Implications of Negative Cardiopulmonary Interactions in Coexisting Chronic Obstructive
J Alberto Neder1, Alcides Rocha2, Danilo C Berton3
1Laboratory of Clinical Exercise Physiology, Division of Respirology and Sleep Medicine, Department of Medicine, Kingston Health Science Center, Queen's University, Richardson House, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada.
Abstract:
Chronic obstructive pulmonary disease (COPD) and heart failure with reduced ejection fraction (HF) frequently coexist in the elderly. Expiratory flow limitation and lung hyperinflation due to COPD may adversely affect central hemodynamics in HF. Low lung compliance, increased alveolar-capillary membrane thickness, and abnormalities in pulmonary perfusion because of HF further deteriorates lung function in COPD. We discuss how those negative cardiopulmonary interactions create challenges in clinical interpretation of pulmonary function and cardiopulmonary exercise tests in coexisting COPD-HF. In the light of physiologic concepts, we also discuss the influence of COPD or HF on the current medical treatment of each disease.
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