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Coexisting chronic obstructive pulmonary disease and cardiovascular disease in clinical practice: a diagnostic and therapeutic challenge

Paul Leong, Martin I Macdonald, Brian S Ko and Phil G Bardin
Med J Aust || doi: 10.5694/mja2.50120
Published online: 8 April 2019

Summary

 

  • Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently coexist but combined disease is often not recognised. Since symptoms overlap significantly, it is common for patients’ presentations to be attributed to one disease alone, and for the other to be overlooked.
  • The effect of COPD and CVD goes beyond the shared risk factors of smoking and advancing age. The presence of COPD adversely affects cardiac disease and vice versa. In comparison to individuals with one disease alone, those with both conditions have a higher mortality rate, experience more frequent exacerbations with more hospitalisations and have worse quality of life.
  • More patients with mild and moderate COPD die from CVD than from COPD, and there is a higher rate of arrhythmias, particularly atrial fibrillation. Accurate and timely diagnosis is therefore crucial.
  • Retrospective evidence indicates that individuals with COPD and CVD may have better outcomes with appropriate CVD pharmacotherapy, yet robust prospective evidence is lacking. Inhaled medications for patients with stable COPD improve quality of life and reduce exacerbations, but there is limited evidence that they reduce mortality.
  • A low threshold for investigation and treatment of CVD in COPD and COPD in CVD is essential.

 

  • Paul Leong1
  • Martin I Macdonald1
  • Brian S Ko2
  • Phil G Bardin1

  • 1 Monash Lung and Sleep, Monash Health, VIC
  • 2 Monash Heart, Monash Health, VIC

Correspondence: paul.leong@monash.edu

Acknowledgements: 

This work was supported by a National Health and Medical Research Council Postgraduate Scholarship.

Competing interests:

No relevant disclosures.

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