Closest friends: Chronic pulmonary disease and systolic heart failure

We read the article “Airway obstruction in systolic heart failure — chronic pulmonary disease (COPD) or congestion?” by Brenner S et al., with interest [1]. The authors aimed to estimate the prevalence, correlates and prognostic impact of true COPD in patients with systolic heart failure (SHF). They concluded that airway obstruction is a dynamic phenomenon in SHF. Therefore, a valid diagnosis of COPD in SHF demands serial pulmonary function testing (PFT) under stable conditions with special attention to hyperinflation. They suggested that in order to avoid potentially harmful overtreatment, bronchodilators should only be permanently applied if COPD has been unequivocally confirmed. COPD and heart failure are closest friends, have common features. Etiologic factors, clinical presentation and laboratory findings may be similar. Therefore, differential diagnosis and management of this disease have been a problem for clinicians at all times [2,3]. Many studies found a high prevalence of COPD inpatientswith heart failure. As in the present study, we think that especially patients with heart failure have an exaggerated diagnosis of COPD. That's why, for distinguishing these two diseases, it is important to reveal and determine the clinical, laboratory, echocardiographic and radiological data [4]. In the present study, the authors used the PFT changes after 6 months of therapy as the powerful tool in the differential diagnosis of COPD and heart failure which is also supported by the body plethysmography. We think that body plethysmography may have a pivotal role in this diagnostic strivingbecause PFTmeasures alonedonot have the power to differentiate between both diseases. Although the diagnosis of COPD was excluded by reversible PFT in the present study, we know that there are different phenotypes of COPD with reversible PFT in clinical practice. Additionally, although it is not mentioned in the presented study, we consider that radiological findings may have pivotal role in differential diagnosis. Chest X-ray does not give strong evidence to distinguish both diseases because cardiothoracic ratio adversely affected by hyperinflated lungs and left ventricular dilatation can be masked by right ventricular enlargement caused by COPD. The observation of parenchymal changes such as emphysema and interstitial edema in CT scans may be helpful. Finally, sodium retention and lifestyle change programs such as exercise are frequent priorities for mortality and morbidity in people with heart failure [5]. Furthermore, the frequency and severity of hospitalization may be associated with HF risk factors including increasing age, anemia, duration of diabetes, obstructive sleep apnea, obesity, hypertension, lifestyle programs and psychological disturbances [6]. In this point of view, if future follow-up studies assess the patients with systolic heart failure according to sodium intake and lifestyle change programs, it'll contribute to the literature. In conclusion, we think that these two diseases will continue to be close friends for a while. To shorten this period, diagnosis, treatment and outcomes should be examined with great care and more studies should be done.