Minasian AG, van den Elshout FJJ, Dekhuijzen PNR, Vos PJE, Willems FF, van den Bergh PJPC, Heijdra YF. COPD in chronic heart failure: less common than previously thought?
Heart Lung 2014;
42:365-71. [PMID:
23998385 DOI:
10.1016/j.hrtlng.2013.07.002]
[Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 06/29/2013] [Accepted: 07/01/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND
Using a fixed ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) < 0.70 instead of the lower limit of normal (LLN) to define chronic obstructive pulmonary disease (COPD) may lead to overdiagnosis of COPD in elderly patients with heart failure (HF) and consequently unnecessary treatment with possible adverse health effects.
OBJECTIVE
The aim of this study was to determine COPD prevalence in patients with chronic HF according to two definitions of airflow obstruction.
METHODS
Spirometry was performed in 187 outpatients with stable chronic HF without pulmonary congestion who had a left ventricular ejection fraction <40% (mean age 69 ± 10 years, 78% men). COPD diagnosis was confirmed 3 months after standard treatment with tiotropium in newly diagnosed COPD patients.
RESULTS
COPD prevalence varied substantially between 19.8% (LLN-COPD) and 32.1% (GOLD-COPD). Twenty-three of 60 patients (38.3%) with GOLD-COPD were potentially misclassified as having COPD (FEV1/FVC < 0.7 but > LLN). In contrast to patients with LLN-COPD, potentially misclassified patients did not differ significantly from those without COPD regarding respiratory symptoms and risk factors for COPD.
CONCLUSIONS
One fifth, rather than one third, of the patients with chronic HF had concomitant COPD using the LLN instead of the fixed ratio. LLN may identify clinically more important COPD than a fixed ratio of 0.7.
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