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. 2023 Sep 19:18:2055-2064.
doi: 10.2147/COPD.S425592. eCollection 2023.

Applying the Rome Proposal on Exacerbations of Chronic Obstructive Pulmonary Disease: Does Comorbid Chronic Heart Failure Matter?

Petra Kristina Jacobson  1   2 , Leili Lind  3   4 , Hans L Persson  1   2
Affiliations

Applying the Rome Proposal on Exacerbations of Chronic Obstructive Pulmonary Disease: Does Comorbid Chronic Heart Failure Matter?

Petra Kristina Jacobson et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Chronic heart failure (CHF) is a common comorbidity among patients with chronic obstructive pulmonary disease (COPD). Both exacerbations of COPD (ECOPDs) and exacerbations of CHF (ECHFs) display worsening of breathlessness at rest (BaR) and breathlessness at physical activity (BaPA). Comorbid CHF may have an impact on the vital signs assessed, when the Rome proposal (adopted by GOLD 2023) is applied on ECOPDs. Thus, the aim of the present study was to investigate the impact of comorbid CHF on ECOPDs severity, particularly focusing on the influence of comorbid CHF on BaR and BaPA.

Methods: We analysed data on COPD symptoms collected from the telehealth study The eHealth Diary. Patients with COPD (n = 43) and patients with CHF (n = 41) were asked to daily monitor BaR and BaPA, employing a digital pen and scales for BaR and BaPA (from 0 to 10). Twenty-eight patients of the COPD patients presented with comorbid CHF. Totally, 125 exacerbations were analysed.

Results: Exacerbations in the group with COPD patients and comorbid CHF were compared to the group with COPD patients without comorbid CHF and the group with CHF patients. Compared with GOLD 2022, the GOLD 2023 (the Rome proposal) significantly downgraded the ECOPD severity. Comorbid CHF did not interfere significantly on the observed difference. Comorbid CHF did not worsen BaR scores, assessed at inclusion and at the symptom peak of the exacerbations.

Conclusion: In the present study, we find no evidence that comorbid CHF would interfere significantly with the parameters included in the Rome proposal (GOLD 2023). We conclude that the Rome proposal can be safely applied even on COPD patients with very advanced comorbid CHF.

Keywords: COPD symptoms; chronic heart failure; telemedicine; telemonitoring.

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Conflict of interest statement

PKJ reports honoraria for lectures from Chiesi. HLP reports honoraria for advisory boards/lectures from AstraZeneca, Boehringer Ingelheim, GlaxoSmithCline, Intermune, Roche and the Swedish Medical Products Agency. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
BaR and BaPA at base-line study day 1 (at inclusion). The groups were all COPD patients (n = 43), two subgroups of COPD patients, that is those without comorbid CHF (n = 15) and those with comorbid CHF (n = 28), and CHF patients (n = 41). Mean values ±1 S.D. are indicated. *p ˂0.05.
Figure 2
Figure 2
BaR and BaPA at the peak of the exacerbations (day 15). The groups were the ECOPDs of all COPD patients (n = 107), two subgroups of ECOPDs, that is those without comorbid CHF (n = 61) and those with comorbid CHF (n = 46), and the ECHFs of CHF patients (n = 18). Mean values ±1 S.D. are indicated. *p ˂0.05; **p ˂0.01, ***p ˂0.001.
Figure 3
Figure 3
(A) Mean values day-by-day during the exacerbation. Day 15 is the day when the exacerbation was diagnosed by HBHC staff and treatment with steroids and/or antibiotics (the ECOPDs) or diuretics (the ECHFs) was started. BaR (filled symbols) and BaPA (open symbols) during exacerbations among patients with COPD (all; blue squares and blue lines; n = 107) and patients with CHF (red circles and red lines; n = 18). (B and C) show the mean values adjusted to a shared baseline for BaPA (B) and BaR (C).
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