Congestive heart failure (CHF) is a condition that occurs when the heart becomes too weak to effectively pump blood out to the rest of the body. In turn, fluid levels build up and blood can back up into both the heart and lungs, leading to shortness of breath. For most CHF patients, difficulty breathing does not occur when they are at rest, but even small amounts of exertion can cause symptoms to begin.
Loading the player...Differentiating Between COPD and Heart Failure in Patients Dr. Sean Virani, MD, MSc., MPH, FRCPC, FCCS, Cardiologist and Dr. Donald Sin, MD, FRCP MPH, Respirologist, discuss how patients and doctors can distinguish between COPD and Heart Failure.
Loading the player...The Treatment of COPD Dr. Donald Sin, MD, FRCP, MPH, Respirologist, discusses treatment options for COPD.
Loading the player...Asthma and COPD Treatment With Inhalers Colin Holyk, BSc (Pharm) Pharmacist, discusses Asthma and COPD Treatment With Inhalers
Loading the player...What is COPD (Chronic Obstructive Pulmonary Disease)? Dr. Donald Sin, MD, FRCP, MPH, Respirologist, discusses what causes COPD .
Dr. Virani: Shortness of breath is a common feature of both heart failure and COPD. Complicating matters further is the fact that many patients with COPD will have heart failure and vice versa. So oftentimes it’s really challenging for the physician and for the patient to know whether their dysthymia is due to heart failure, COPD or both.
Dr. Sin: Many patients with COPD also have heart disease. It’s estimated that about four in ten COPD patients have a concomitant heart failure disorder. And both of these conditions cause shortness of breath, so diagnostically it may be very hard for you and your doctors to separate out COPD from heart failure—what’s causing what.
In this case, more advanced diagnostics may be required to really understand what’s driving your symptoms. Some of those diagnostics may include blood test; so there is a very sensitive blood test for heart failure—it’s called BNP. And that your doctor can order to see whether it’s the heart failure that’s driving the shortness of breath.
Dr. Virani: Natriuretic peptide testing is the gold standard for differentiating heart failure from COPD. Natriuretic peptides are elevated in patients with heart failure, however when levels are low it virtually excludes heart failure as a cause for the patient’s shortness of breath, leading us to think that COPD is probably the driver of their symptoms.
Dr. Sin: Another test that can be done is a chest x-ray to see if your lungs are full of water or full of holes, as in the case of emphysema. Another more sophisticated test would be a CT scan of your chest, and that would give you a very clear picture of the role that heart and lung is playing in driving the shortness of breath, or cough or recurrent chest infections.
Dr. Virani: It’s important to differentiate COPD from heart failure because the treatments will be clearly different, and so understanding the cause of the patient’s symptoms is paramount to understanding the best way to treat them.
Dr. Sin: It’s very important to sort out what’s driving the symptoms. Is it the heart failure? Is it the COPD? Or is it both? Because the treatment for these disorders are different. So for instance for heart failure, the treatment may be a water pill to relieve the pulmonary congestion. If it’s a COPD flare-up, it may be in the form of an inhaler, or antibiotics or a steroid to reduce the inflammation. So getting the diagnosis right in a specific patient is very, very important for how the therapeutics will treat those patients.
Dr. Virani: If you have patients with heart failure and COPD and are unclear about what the cause of their symptoms are, I’d encourage you to get a natriuretic peptide test done on your patient to help clarify the situation. Presenter: Dr. Sean Virani, Cardiologist, Vancouver, BC
Regarding patients who have difficulties with breathing - perhaps they’re asthmatic or they are COPD patients - there’s a number of different inhalers available to help them with their breathing. The first type of inhaler would be a bronchodilator inhaler, and the bronchodilator inhalers are used to basically open up the airways to the lung, to get more air in and out of the lung. That would be a style of the bronchodilator.
A second kind of medication by inhaler is a straight corticosteroid, and these medications are used to reduce the inflammation and swelling in the lung and reduce the secretions of mucous in the lung to allow better air exchange in the lung. Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition.
The third type of an inhaler is actually one that is a combination and this contains a corticosteroid to reduce the inflammation and swelling, and also a long-acting bronchodilator which is used on a regular basis so it’s a two-in-one combination.
So the bronchodilator inhaler would be a benefit for patients who have been recently diagnosed with some breathing difficulties, or if they’ve had a cold or a flu and they’ve had some breathing difficulties. It’s also used for patients with exercise-induced asthma, prior to exercising, if they take a dose of this medication it will help open up their airways. For patients who have a longer standing difficulty with breathing the doctor may prescribe a steroid medication, a corticosteroid, and use that sometimes in addition to the bronchodilator.
The corticosteroid will help reduce the inflammation and swelling in the lung. The patient might still require the bronco bronchodilator for what we call rescue, for their breathing, to open up the airways.
The third type of medication that we described is a combination of the long-acting bronchodilator and the steroid. So you’re getting the benefit of reduced inflammation and swelling in the lung tissue. You’re getting the benefit of a long acting bronchodilator to keep the airways open, and patients might be on that. They also may still require that short acting bronco just to open up the airways if they’re acutely in trouble. Presenter: Mr. Colin Holyk, Pharmacist, Vancouver, BC