Cardiovascular risk, chronic obstructive pulmonary disease and pulmonary rehabilitation

Abstract

Patients with chronic obstructive pulmonary disease (COPD) who participate in pulmonary rehabilitation (PR) often have concomitant cardiovascular disease (CVD), which is a frequently undiagnosed and undertreated comorbidity. CVD contributes to the burden of the disease and is associated with an increased risk for hospitalizations and mortality. Optimizing the diagnosis and management of cardiovascular risk and disease should be considered as part of the holistic approach of PR. In addition, we need to consider similarities and differences in cardiac and PR programs, in order to improve personalized care in patients with both diseases. The current review addresses the burden of CVD in COPD patients who participate in PR, how CVD and its risk factors affect PR and should be managed during PR, and extends on what we can learn of the organization of cardiac rehabilitation programs.

Cardiovascular disease and COPD: dangerous liaisons?

“…Aside from pharmacological strategies, pulmonary rehabilitation (PR) is recommended for patients with COPD as part of integrated patient management [1]. For those with CVD, it is important to consider both diseases when creating PR programmes [150]. Retrospective analyses and prospective studies provide conflicting insight into the effect of CVD on PR efficacy, with the former suggesting a reduction in the ability to achieve a clinically-important difference in 6-minute walking distance and health status in patients with metabolic diseases versus those without [151].…”

Bewegungstraining bei Patienten mit chronischen Atemwegserkrankungen: Werden kardiovaskuläre Komorbiditäten und Outcomes berücksichtigt? Eine systematische Übersichtsarbeit

“…Kardiovaskuläre Erkrankungen (wie arterielle Hypertonie, koronare Herzkrankheit, kongestive Herzinsuffizienz, periphere Gefäßerkrankungen und pulmonale Hypertonie) gehören zu den Komorbiditäten mit der höchsten Prävalenz und den stärksten Auswirkungen bei Patienten mit COPD (13%–68% der Bevölkerung), Asthma (3%–25% der Bevölkerung) und ILD (8%–86% der Bevölkerung) [6-13]. Sie verschlechtern den funktionellen Status und die gesundheitsbezogene Lebensqualität der Patienten noch weiter, erhöhen das Hospitalisierungs- und Mortalitätsrisiko (Hazard Ratio (HR) 1,1–3,4 [14-17]) und tragen so zu einer erhöhten wirtschaftlichen und gesellschaftlichen Belastung sowie zu einer Verschlechterung der Prognose bei [7, 9, 10, 12]. Daher sollte bei der Behandlung dieser Patienten der Blick über die Lunge hinaus gehen [18] und eine umfassende Beurteilung sowie Behandlung der kardiovaskulären Komorbiditäten mit maßgeschneiderten Interventionen wurde empfohlen [7, 12, 19, 20].…”

Outcome measures in a combined exercise rehabilitation programme for adults with COPD and chronic heart failure: A preliminary stakeholder consensus event

“…58,59 Many review articles have suggested this is an area of future research. [60][61][62] Skeletal muscle dysfunction is well recognised in COPD and CHF 10 and is a frequently reported measure in PR studies, although less commonly in CHF rehabilitation studies. Interestingly, the measurement Health-related quality of life Largely generic questionnaire, such as the potential use of the EuroQol 5D-3L, 26 EuroQol 5D-5L, 27 World Health Organisation quality of life (WHOQOL)-100 28,29 or WHOQOL-BREF 30…”