Comorbidity of heart failure and chronic obstructive pulmonary disease: more than coincidence

Heart failure and COPD are very common in the elderly. As both syndromes share common risk factors, such as tobacco smoking, and pathophysiological pathways, including systemic inflammation and activation of the neurohumoral system, they frequently coincide. Because of the similar clinical presentation, diagnoses of COPD in the presence of heart failure may be difficult. If spirometry is performed, caution should be taken in the interpretation of the data, as heart failure by itself (in the absence of true COPD) may exert restrictive as well as obstructive alterations in pulmonary function testing. Once COPD is established, concurrent heart failure may impact on the accurate management of these patients as severity grading of COPD could easily be overrated, and thus there is a risk of overuse of pulmonary medication, with the risk of causing cardiac side-effects. The present review focuses on the pathophysiological interrelation of comorbid COPD and heart failure, and provides practical help on how to deal with both diseases in daily practice.