Comorbidity: COPD

Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are two different medical conditions with similar symptoms. Considered comorbidities, they can be present at the same time and exacerbate (or worsen) each other.1-2 Similarly, neither condition currently has a cure. Common treatment goals for COPD and HF are to manage symptoms and slow disease progression.3 Your doctor can treat you for both COPD and HF at the same time.4

COPD and HF can both affect the ability to breathe. With similar symptoms and risk factors, both diseases can impact activities of daily living.3 COPD and HF are also conditions that are characterized by exacerbations, periods of time where symptoms worsen and then improve repeatedly.4 COPD exacerbations can be caused by infections, colds, smoke, and chemical fumes. HF exacerbations may be caused by dietary changes, medications, and general health status.4

COPD

According to the COPD Foundation, “Chronic Obstructive Pulmonary Disease is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma”; characterized by increasing breathlessness.

Common symptoms of COPD include:1

COPD and HF develop for different reasons; one is a primary disease of the lungs, the other of the heart.1,3 But smoking, which is the most common reason for developing COPD, is also a risk factor for heart failure.3 It is important to note that those who quit smoking can improve their general health and the status of these conditions. Other causes of COPD include chronic bronchitis and emphysema which can cause irritation or damage to the airways in the lungs.2

Shortness of Breath

As heart failure advances, fluid can build up causing it to back up in the lungs and other tissues; this can contribute to swelling and shortness of breath, especially when physically active.2

With COPD it is hard to take a complete breath. Changes occur in the lungs that decrease how much air a person can inhale or exhale. COPD can cause low levels of oxygen in the blood, putting added stress on the heart. This can impair left-sided heart failure as well as worsen the symptoms of COPD. The body tries to compensate for the low oxygen levels by pumping more blood around and breathing in more oxygen.

COPD and HF

Nearly a third of people with COPD also have congestive heart failure.4 It is also associated with left-sided and right-sided heart failure. The fluid that builds up in the lungs, consistent with left-sided HF, can aggravate COPD symptoms. And although right-sided heart failure alone is not very common, COPD is one of the causes. This is because the low oxygen levels can cause an increase in arterial blood pressure within the lungs, called pulmonary hypertension. This results in additional strain on the right ventricle as it pumps blood through the lungs. This can cause the heart muscle to weaken resulting in right-sided heart failure.2

Medical care may involve a team that includes a primary care physician, a cardiologist, and a pulmonologist. Sometimes both conditions can flare up at the same time and it can be difficult to know which is causing the symptoms.

Treatment

To select the appropriate treatment for your symptoms, your provider will perform a physical exam. They will listen to your lungs to hear if they detect wheezing consistent with COPD. If you have heart failure the sound will be different. They will listen to see if they hear a crackle which is consistent with fluid buildup.2

You will be examined for the presence of swelling, specifically distention in the veins of the neck which is indicative of HF but not COPD.4 HF also causes swelling in the feet and ankles, which is not a symptom of COPD.4

Other tests that can be used to determine if you have COPD or HF include echocardiograms and blood tests. The echocardiogram offers an ultrasound image of the heart showing blood flow and pumping function. A normal function may indicate that COPD is the main cause of the symptoms. If the ejection fraction is reduced, it is more likely that heart failure is causing the symptoms. Blood tests looking at BNP, brain natriuretic peptide, may be elevated in people with a HF exacerbation.4

Identifying the cause of an exacerbation is important, as treatment selection will likely be different depending on the root cause.4 Sometimes you will be treated for both COPD and HF symptoms at the same time.

Managing HF and COPD involves more than just treatment with medications. Physical exercise and quitting smoking, if you do smoke, are important steps in taking care of yourself. Regular physical activity helps to strengthen the heart and lungs. There are tailored exercise programs for both COPD and HF. Ask your healthcare team about pulmonary or cardiac rehabilitation or an exercise regimen that is appropriate for your medical and general health condition.2

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Written by: Linda Minton | Last reviewed: November 2019