The interplay between symptom deterioration of chronic obstructive pulmonary disease and chronic heart failure

Abstract

Background

Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) commonly co-exist and share symptoms, which complicates disease management. It is unclear how COPD and CHF deterioration inter(re)act.

Objective

This study aimed to assess the interplay between COPD and CHF deterioration on group and individual level.

Methods

Total daily COPD- and CHF-symptom intensity scores (SIS) were calculated based on increased symptoms of COPD (dyspnea, sputum purulence and color, coughing, wheezing, fever) and CHF (sudden weight increase, swelling, nocturnal dyspnea), as reported by patients in one-year daily symptom diaries. The COPD-CHF interplay was assessed visually and statistically (on group and individual level) by mixed models.

Results

From a multicenter trial (N = 201), 33 patients with COPD and CHF (72.4 ± 7.8 years, 24 men (72.7 %)) were included. On group level, increased CHF-SIS positively predicted next day’s COPD-SIS (p = 0.02). However, on individual level, the direction and strength of the associations between CHF-SIS and subsequent COPD-SIS varied substantially. Vice versa, increased COPD-SIS also predicted next day’s CHF-SIS on group level (p < 0.001). On individual level, the direction of the associations varied less, although strength differed from negligible to strongly positive.

Conclusions

On group level, CHF deterioration predicts an increase in next day’s COPD symptom score, as well as vice versa. Individual-level associations reinforce the group-level results for COPD provoking CHF symptoms, but not for CHF provoking COPD symptoms. The COPD-CHF interplay should be monitored and, if present, acted upon to optimize patient disease management.