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已发表论文
COPD-哮喘-心力衰竭重叠：高风险三联病中的支气管扩张剂和ICS优化
Received 19 August 2025
Accepted for publication 12 December 2025
Published 28 January 2026 Volume 2026:19 561811
DOI https://doi.org/10.2147/JAA.S561811
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Luis Garcia-Marcos
Xiaokai Fu,1 Genpeng Han2
1Department of Pharmacy, Changle People’s Hospital Affiliated to Shandong Second Medical University, Weifang City, Shandong Province, 261000, People’s Republic of China; 2Department of Respiration, Weifang Hospital of Traditional Chinese Medicine, Weifang City, Shandong Province, 261000, People’s Republic of China
Correspondence: Genpeng Han, Department of Respiration, Weifang Hospital of Traditional Chinese Medicine, No. 1055, Weizhou Road, Kuwen District, Weifang City, Shandong Province, 261000, People’s Republic of China, Email hangenpeng2009@163.com
Abstract: Chronic obstructive pulmonary disease (COPD), asthma, and heart failure (HF) frequently coexist, forming a high-risk clinical triad characterized by overlapping symptoms and pathophysiological mechanisms. This COPD-asthma-HF overlap complicates diagnosis and treatment due to shared clinical features such as dyspnea, wheezing, and exercise intolerance. Epidemiologically, up to 30% of COPD patients have concomitant HF, while 15– 20% of obstructive airway disease patients exhibit asthma-COPD overlap, many of whom also develop HF due to chronic hypoxia, systemic inflammation, or shared risk factors like smoking. The interplay between these conditions is driven by chronic inflammation, airway obstruction, and cardiac dysfunction, creating a self-perpetuating cycle of disease progression. Inflammation in COPD and asthma contributes to endothelial dysfunction and atherosclerosis, exacerbating HF, while HF-induced hypoxia and congestion worsen pulmonary inflammation. Diagnostic challenges arise from overlapping symptoms and limitations of traditional tools such as spirometry and biomarkers, necessitating a multimodal approach. Therapeutic management is complex, as treatments for one condition may worsen another (eg, beta-agonists exacerbating HF or diuretics increasing mucus viscosity in COPD). Precision medicine approaches targeting treatable traits such as eosinophilic inflammation, fluid overload, and bronchospasm offer a strategic framework for personalized care. Pharmacological strategies must balance bronchodilation, anti-inflammatory effects, and cardiac support, with careful consideration of drug safety profiles. This review highlights the need for integrated diagnostic and therapeutic strategies to optimize outcomes in this high-risk population, emphasizing the importance of recognizing shared pathophysiology and individualized management.
Keywords: COPD, asthma, heart failure, overlap symptoms, pharmacological intervention
1Department of Pharmacy, Changle People’s Hospital Affiliated to Shandong Second Medical University, Weifang City, Shandong Province, 261000, People’s Republic of China; 2Department of Respiration, Weifang Hospital of Traditional Chinese Medicine, Weifang City, Shandong Province, 261000, People’s Republic of China
Correspondence: Genpeng Han, Department of Respiration, Weifang Hospital of Traditional Chinese Medicine, No. 1055, Weizhou Road, Kuwen District, Weifang City, Shandong Province, 261000, People’s Republic of China, Email hangenpeng2009@163.com
Abstract: Chronic obstructive pulmonary disease (COPD), asthma, and heart failure (HF) frequently coexist, forming a high-risk clinical triad characterized by overlapping symptoms and pathophysiological mechanisms. This COPD-asthma-HF overlap complicates diagnosis and treatment due to shared clinical features such as dyspnea, wheezing, and exercise intolerance. Epidemiologically, up to 30% of COPD patients have concomitant HF, while 15– 20% of obstructive airway disease patients exhibit asthma-COPD overlap, many of whom also develop HF due to chronic hypoxia, systemic inflammation, or shared risk factors like smoking. The interplay between these conditions is driven by chronic inflammation, airway obstruction, and cardiac dysfunction, creating a self-perpetuating cycle of disease progression. Inflammation in COPD and asthma contributes to endothelial dysfunction and atherosclerosis, exacerbating HF, while HF-induced hypoxia and congestion worsen pulmonary inflammation. Diagnostic challenges arise from overlapping symptoms and limitations of traditional tools such as spirometry and biomarkers, necessitating a multimodal approach. Therapeutic management is complex, as treatments for one condition may worsen another (eg, beta-agonists exacerbating HF or diuretics increasing mucus viscosity in COPD). Precision medicine approaches targeting treatable traits such as eosinophilic inflammation, fluid overload, and bronchospasm offer a strategic framework for personalized care. Pharmacological strategies must balance bronchodilation, anti-inflammatory effects, and cardiac support, with careful consideration of drug safety profiles. This review highlights the need for integrated diagnostic and therapeutic strategies to optimize outcomes in this high-risk population, emphasizing the importance of recognizing shared pathophysiology and individualized management.
Keywords: COPD, asthma, heart failure, overlap symptoms, pharmacological intervention