New insight into congestive heart failure and chronic obstructive pulmonary disease - A common but ignored concomittant disease

The coexistence of congestive heart failure and chronic obstructive pulmonary disease is common in patients with acute dyspnea. The frequency of coexistence is far beyond our imagination. Clinical diagnosis is difficult to make because they share common but nonspecific symptoms and signs. Brain natriuretic peptide (BNP) is a useful serum biomarker to differentiate acute exacerbation of congestive heart failure from chronic obstructive pulmonary disease. Acute exacerbation of congestive heart failure could be excluded if BNP level is less than 100 pg/mL. Acute exacerbation of congestive heart failure is highly suspected if BPN level is more than 500 pg/mL. Treatment of this common concomitant disease is usually suboptimal because of being afraid of their contra-indication. To the best of our knowledge, there is no large clinical trial regarding this issue so far. In this review, we try to highlight the comorbidity, prognostic impact, diagnostic confusion and therapeutic dilemma of both diseases.