This patient is not breathing properly: is this COPD, heart failure, or neither?

INTRODUCTION: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are two common, heterogeneous, long-term illnesses which cause significant morbidity and mortality. Although they both present with breathlessness, they are treated differently. Treatment of COPD focuses mainly on relieving short-term breathlessness, whilst treatment of HF has focused on long term morbidity and mortality. Areas covered: In this review, we aim to highlight the diagnostic challenges in distinguishing COPD from HF. We also explore the implications of their overlap, and the use of biomarkers and treatments for HF in patients with COPD to improve long-term outcomes. Expert commentary: Cardiovascular morbidity and mortality amongst patients with COPD is substantial. Approaches which identify patients with COPD at highest cardiovascular risk may therefore be helpful. A trial targeting those patients with COPD and raised natriuretic peptide levels might be the way to test whether cardiovascular medication has anything to offer the respiratory patient.