Implications of Cardiopulmonary Risk for the Management of COPD: A Narrative Review

Dave Singh¹, MeiLan K Han², Nathaniel M Hawkins³, John R Hurst⁴, Janwillem W H Kocks^{5

6

7

8}, Neil Skolnik⁹, Daiana Stolz¹⁰, Jad El Khoury¹¹, Chris P Gale^{12

13

14}

Affiliations

¹ Medicines Evaluation Unit, Manchester University NHS Foundation Trust, University of Manchester, Manchester, M23 9QZ, UK. dsingh@meu.org.uk.
² Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
³ University of British Columbia, Vancouver, BC, Canada.
⁴ UCL Respiratory, University College London, London, UK.
⁵ General Practitioners Research Institute, Groningen, The Netherlands.
⁶ Observational and Pragmatic Research Institute, Singapore, Singapore.
⁷ Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁸ Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁹ Abington Family Medicine, Jenkintown, PA, USA.
¹⁰ Clinic of Respiratory Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
¹¹ AstraZeneca, Cambridge, UK.
¹² Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹³ Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
¹⁴ Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.

PMID: 38664329
PMCID: PMC11133105
DOI: 10.1007/s12325-024-02855-4

Review

Implications of Cardiopulmonary Risk for the Management of COPD: A Narrative Review

Dave Singh et al. Adv Ther. 2024 Jun.

. 2024 Jun;41(6):2151-2167.

doi: 10.1007/s12325-024-02855-4. Epub 2024 Apr 25.

Authors

Dave Singh¹, MeiLan K Han², Nathaniel M Hawkins³, John R Hurst⁴, Janwillem W H Kocks^{5

6

7

8}, Neil Skolnik⁹, Daiana Stolz¹⁰, Jad El Khoury¹¹, Chris P Gale^{12

13

14}

Affiliations

¹ Medicines Evaluation Unit, Manchester University NHS Foundation Trust, University of Manchester, Manchester, M23 9QZ, UK. dsingh@meu.org.uk.
² Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
³ University of British Columbia, Vancouver, BC, Canada.
⁴ UCL Respiratory, University College London, London, UK.
⁵ General Practitioners Research Institute, Groningen, The Netherlands.
⁶ Observational and Pragmatic Research Institute, Singapore, Singapore.
⁷ Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁸ Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁹ Abington Family Medicine, Jenkintown, PA, USA.
¹⁰ Clinic of Respiratory Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
¹¹ AstraZeneca, Cambridge, UK.
¹² Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹³ Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
¹⁴ Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.

PMID: 38664329
PMCID: PMC11133105
DOI: 10.1007/s12325-024-02855-4

Abstract

Chronic obstructive pulmonary disease (COPD) constitutes a major global health burden and is the third leading cause of death worldwide. A high proportion of patients with COPD have cardiovascular disease, but there is also evidence that COPD is a risk factor for adverse outcomes in cardiovascular disease. Patients with COPD frequently die of respiratory and cardiovascular causes, yet the identification and management of cardiopulmonary risk remain suboptimal owing to limited awareness and clinical intervention. Acute exacerbations punctuate the progression of COPD in many patients, reducing lung function and increasing the risk of subsequent exacerbations and cardiovascular events that may lead to early death. This narrative review defines and summarises the principles of COPD-associated cardiopulmonary risk, and examines respiratory interventions currently available to modify this risk, as well as providing expert opinion on future approaches to addressing cardiopulmonary risk.

Keywords: Cardiopulmonary risk; Cardiovascular disease; Chronic obstructive pulmonary disease; Exacerbation; Inhaled therapy; Mortality.

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Conflict of interest statement

Dave Singh has received consultancy fees from Aerogen, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, CSL Behring, EpiEndo, Genentech, GlaxoSmithKline, Glenmark, Gossamer Bio, Kinaset Therapeutics, Menarini, Novartis, Orion, Pulmatrix, Sanofi, Teva, Theravance Biopharma and Verona Pharma. MeiLan K. Han reports personal fees from Aerogen, Altesa BioPharma, Amgen, Apreo Health, AstraZeneca, Boehringer Ingelheim, Cipla, Chiesi, DevPro, Genentech, GlaxoSmithKline, Integrity, Novartis, Teva, MDBriefCase, Medscape, Medwiz, Merck, Mylan, NACE, Polarian, Pulmonx, Regeneron, Roche, RS BioTherapeutics, Sanofi, UpToDate and Verona Pharma; has received either in-kind research support or funds paid to the institution from the American Lung Association, AstraZeneca, Biodesix, Boehringer Ingelheim, the COPD Foundation, Gala Therapeutics, the National Institutes of Health, Novartis, Nuvaira, Sanofi and Sunovion; has participated in data safety monitoring boards for Medtronic and Novartis with funds paid to the institution; and has received stock options from Altesa BioPharma and Meissa Vaccines. Nathaniel M. Hawkins reports grants, speaker bureau, advisory board and consultancy honoraria from pharmaceutical companies including AstraZeneca, Bayer, Boehringer Ingelheim, Novartis and Servier. John R. Hurst has received speaker/consultancy fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Takeda. Janwillem W.H. Kocks reports grants, personal fees and non-financial support from AstraZeneca; grants, personal fees and non-financial support from Boehringer Ingelheim; grants and personal fees from Chiesi; grants, personal fees and non-financial support from GlaxoSmithKline; non-financial support from Mundi Pharma; grants and personal fees from Teva; personal fees from MSD; personal fees from Covis Pharma; personal fees from ALK-Abelló; and grants from Valneva outside the submitted work; holds < 5% shares of Lothar Medtec GmbH and 72.5% of shares in the General Practitioners Research Institute. Neil Skolnik has received speaker/consultancy fees from Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, Genentech, GlaxoSmithKline, Idorsia, Lilly, Merck, Novartis, Sanofi, Sanofi Pasteur and Teva; and research funding from AstraZeneca, Bayer, GlaxoSmithKline, Novo Nordisk and Sanofi. Daiana Stolz is the current GOLD representative for Switzerland and has received speaker/consultancy fees from Almirall, AstraZeneca, Bayer, Boehringer Ingelheim, CSL Behring, GlaxoSmithKline, MSD, Novartis, Sanofi and Vifor; and research grants from AstraZeneca and Curetis. Jad El Khoury is an employee of AstraZeneca and holds shares and stock options in the company. Chris P. Gale has received speaker fees from AstraZeneca, Medisetter, Menarini, Novartis, Raisio Group, Wondr Medical, Zydus; advisory board and consultancy honoraria from AI Nexus, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardiomatics, Chiesi, Daiichi Sankyo, General Practitioners Research Institute, iRhythm, Menarini, Novartis, Organon, Phoenix Group; research grants from Abbott Diabetes, Bristol Myers Squibb, the British Heart Foundation, Horizon 2020, and the National Institute for Health and Care Research.

Figures

**Fig. 1**
COPD-associated cardiopulmonary risk. Arrow type and shade indicate strength of association: strong association, with substantial supporting data (dark grey solid), emerging association, with some supporting data (dark grey dotted), suspected association, with data yet to be generated (light grey dotted). *COPD* chronic obstructive pulmonary disease

See this image and copyright information in PMC

References

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1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease report 2024. https://goldcopd.org/2024-gold-report/. Accessed 5 Jan 2024.
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Implications of Cardiopulmonary Risk for the Management of COPD: A Narrative Review

Affiliations

Implications of Cardiopulmonary Risk for the Management of COPD: A Narrative Review

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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Medical