Clinical and Physiologic Implications of Negative Cardiopulmonary Interactions in Coexisting Chronic Obstructive Pulmonary Disease-Heart Failure

Effects of dapagliflozin in heart failure with reduced ejection fraction and chronic obstructive pulmonary disease: an analysis of DAPA‐HF

“…Although still indicated and generally well tolerated in most patients with COPD, even in high‐risk settings, new evidence also shows that beta‐blockers can increase the risk of respiratory hospitalization in patients with more severe COPD 8,9 . It is also advised that hydralazine and isosorbide dinitrate are avoided in patients with COPD as this combination may lead to worsening gas exchange and hypoxaemia 7 . Similarly, hypokalaemia induced by beta‐agonists, glucocorticoids and xanthine derivatives may make digoxin use more hazardous in patients with COPD, compared to those without and increase risk of arrhythmias 7,10,11 …”

“…It is also advised that hydralazine and isosorbide dinitrate are avoided in patients with COPD as this combination may lead to worsening gas exchange and hypoxaemia 7 . Similarly, hypokalaemia induced by beta‐agonists, glucocorticoids and xanthine derivatives may make digoxin use more hazardous in patients with COPD, compared to those without and increase risk of arrhythmias 7,10,11 …”

Low DLCO predicts all-cause hospital admissions in patients with reduced left ventricular ejection fraction or diastolic dysfunction

“…The diffusing capacity of the lung for carbon monoxide (D LCO ) can be decreased in many disease states, including COPD and interstitial lung disease [1,2]. Low D LCO can also be seen in those with clinically relevant congestive heart failure (CHF) due to its deleterious consequences on lung volumes, perfusion and gas exchange efficiency [3,4]. Pulmonary function testing results are frequently available in patients with CHF.…”

“…Low D LCO could reflect worse pulmonary perfusion secondary to impaired cardiac output and endothelial dysfunction in the lung capillaries [3,4]. Repeated episodes of pulmonary oedema, increased interstitial fluid and alveolar-capillary membrane thickening might play a role.…”

Practical challenges of diagnosing obstruction in the presence of restriction

“…(2) In the present case, a relatively small difference between FVC% (% of predicted) and FEV 1 % (e.g., < 12%), (3) as well as an FVC% < 85% and an FEV 1 /FVC ratio ≥ 55%, (4) might have raised the suspicion of associated restriction-which was confirmed by plethysmography. High BMI, chronic scarring, atelectasis, and cardiomegaly (5) might have all contributed to the restrictive defect. Care should be taken, however, that restriction per se may increase RV/TLC, because increased lung elastic recoil decreases TLC to a greater extent than it decreases RV.…”