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. 2025 Jun 25:20:2073-2090.
doi: 10.2147/COPD.S523865. eCollection 2025.

Chronic Obstructive Pulmonary Disease and the Management of Cardiopulmonary Risk in the UK: A Systematic Literature Review and Modified Delphi Study

Dinesh Shrikrishna  1 , John Steer  2   3 , Beverley Bostock  4   5   6   7   8 , Scott W Dickinson  9 , Alicia Piwko  6   10 , Sivatharshini Ramalingam  11 , Ravijyot Saggu  12 , Carol Ann Stonham  6   13 , Robert F Storey  14   15 , Clare J Taylor  16 , Raj Thakkar  7   9   17   18 , Chris P Gale  19   20   21
Affiliations

Chronic Obstructive Pulmonary Disease and the Management of Cardiopulmonary Risk in the UK: A Systematic Literature Review and Modified Delphi Study

Dinesh Shrikrishna et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Chronic obstructive pulmonary disease (COPD) is linked to increased mortality and morbidity, especially in patients with coexisting cardiovascular disease. These patients face heightened cardiopulmonary risk, which escalates further after acute exacerbations of COPD. While there is some guidance on the management of acute exacerbations of COPD, there is a lack of specific strategies for addressing cardiopulmonary risk in COPD. This program of work aimed to establish UK consensus statements and a clinical pathway for managing cardiopulmonary risk in patients with COPD, synthesizing evidence and expert input through a modified Delphi approach. A multidisciplinary Taskforce conducted a systematic review, focusing on the UK and addressing questions relating to the healthcare burden of acute exacerbations of COPD (AECOPDs), the link between AECOPDs and cardiopulmonary events, the management of cardiopulmonary risk in patients with COPD, and the guidelines and interventions implemented to optimize COPD management. The evidence identified was summarized and used to synthesize preliminary consensus statements reflecting the current situation and recommendations for action. Following iterative voting rounds, consensus was reached on 18 statements. Further to this, a clinical pathway framework to support the recognition and management of cardiopulmonary risk in patients with COPD using the consensus statements was formulated. AECOPDs were identified as a substantial healthcare burden in the UK, contributing to high mortality, frequent healthcare interactions, and elevated costs. These exacerbations were associated with cardiopulmonary events such as myocardial infarction and stroke. Most UK guidelines have focused on the respiratory management of COPD exacerbations, but lack strategies to specifically address cardiopulmonary risk, highlighting the need for integration of care. This consensus program has identified gaps in management, as well as a need to optimize care and reduce the cost of COPD management through the development of new UK policies and clinical guidance.

Keywords: COPD; United Kingdom; cardiovascular disease; interdisciplinary health teams.

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Conflict of interest statement

All authors are members of the UK Cardiopulmonary Taskforce, which is sponsored by AstraZeneca. DS has received consultancy and speaker fees from Astra Zeneca, GSK, Boehringer Ingelheim, BMS, Sanofi, Regeneron, Chiesi, Pfizer, and TEVA. These are outside of the submitted work. BB has received honoraria from AstraZeneca, Chiesi, GlaxoSmithKline, Orion, Sanofi, and TEVA. She also reports board membership of Association of Respiratory Nurses, Executive Committee Member Primary Care Cardiovascular Society, President-Elect Primary Care Cardiovascular Society. These are outside of the submitted work. SWD is a former employee of AstraZeneca during the conduct of the study and may hold stock and/or stock options in the company. AP has received honoraria and speaker fees from AstraZeneca, Chiesi, and Sanofi. These are outside of the submitted work. SR has received honoraria from AstraZeneca, Ferring, Accord, and Novartis and is employed as a Medical Advisor for Iowna Health. These are outside of the submitted work. RS has received honoraria from AstraZeneca, Chiesi, GSK, PM Healthcare, Regeneron, Sanofi, and TEVA. These are outside of the submitted work. RFS has received research grants/support from AstraZeneca and Cytosorbents; and personal fees from Abbott, Afortiori Development/Thrombolytic Science, Alfasigma, AstraZeneca, Boehringer Ingelheim/Lilly, Bristol Myers Squibb/Johnson & Johnson, Chiesi, Daiichi Sankyo, Idorsia, Novartis, Novo Nordisk, Pfizer, PhaseBio, and Tabuk. These are outside of the submitted work. CS has received honoraria from AstraZeneca, Bedfont Scientific, Chiesi, GSK, Orion, and Trudell. She was Trustee and previous policy lead for PCRS-UK, as well as current Vice Chair of Taskforce for Lung Health. These are outside of the submitted work. RT has received honoraria from Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Edwards, Medtronic, Novartis, and Omron. RT is employed by AstraZeneca and may hold stock and/or stock options in the company. These are outside of the submitted work. CJT has received consultancy and speaker fees from Astra Zeneca, Bayer, Edwards, and Roche. These are outside of the submitted work. CPG has received grants or contracts from Alan Turing Institute, British Heart Foundation, National Institute for Health Research, Horizon 2020, Abbott Diabetes, Bristol Myers Squibb, European Society of Cardiology, as well as receiving consulting fees from AI Nexus, AstraZeneca, Amgen, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, and CardioMatics, and honoraria from AstraZeneca, Boston Scientific, Menarini, Novartis, Raisio Group, Wondr Medical, Zydus, Chiesi, Daiichi Sankyo, GPRI Research B.V., Novartis, iRhythm, Organon, and The Phoenix Group. These are outside of the submitted work. JS has received research grants from Chiesi Ltd and Menarini, and honoraria from AstraZeneca. These are outside of the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Cardiopulmonary Risk Matrix.
See this image and copyright information in PMC

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