Chronic obstructive pulmonary disease and heart failure: Common diseases of the elderly, frequent non-recognition and the value of specialist referral

Chronic Obstructive Pulmonary Disease (COPD) and Heart Failure (HF) are major and increasing public health problems worldwide. Both conditions are common diseases of the elderly and often coexist. Unfortunately their coexistence frequently remains unrecognized mainly due to the similarities in clinical presentation and additionally due to a lack of relevant studies addressing the combination of HF and COPD. The coexistence of HF and COPD presents many diagnostic challenges. Several tests can be performed to assist in the diagnosis of each disease. Assessment of left ventricular function by transthoracic echocardiography is mandatory for diagnosing HF, while magnetic resonance imaging is the modality of choice in those with limited acoustic windows. On the other hand, objective evidence of airflow obstruction, demonstrated when clinically euvolemic is mandatory for diagnosing COPD. Greater collaboration is required between cardiologists, pulmonologists, and general practitioners. Both are chronic progressive diseases and their prognosis combined is poorer than for either disease alone, therefore it is really important to recognize the coexistence of both processes early.