Chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) share many of the same risk factors.  The presence of IHD in patients with COPD is much greater than in the general population.  The association is so strong that a work up for patients with COPD should include a search for heart disease.  Surprisingly, this type of assessment is not routine.  What is even more surprising is the fact that little if any attention is given to looking for COPD in patients being evaluated for IHD. US investigators recently analyzed data from a large European study looking at patients from cardiovascular clinics.

The investigation revealed two important findings: first, a large number of patients with IHD (30%) had undiagnosed moderate to severe COPD; and second, the presence of airflow limitation (COPD) resulted in morbidity which included more respiratory symptoms, poor general health and more frequent emergency room visits.  Since we already know that COPD and IHD result from many of the same risk factors, especially smoking, a patient found to have coronary artery disease and a history of smoking should routinely have a pulmonary function test done as part of the overall work up.  Conversely, a patient found to have COPD should have an appropriate cardiac study, such as a nuclear stress test, to rule out ischemic heart disease. Both pulmonologists and cardiologists bear the responsibility to be certain that they are not missing an important comorbidity, regardless of which direction the patient comes to our attention from.