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Pneumologie 2019; 73(11): 651-669
DOI: 10.1055/a-0914-9566
Symposiumsbericht
© Georg Thieme Verlag KG Stuttgart · New York

Expertentreffen COPD: Lunge und Herz – ziemlich oft gemeinsam krank![*]

Expert Workshop COPD: Lungs and Heart – Quite Often Ill Together
B. Jany
 1   ehem. Medizinische Klinik, Klinik für Pneumologie und Beatmungsmedizin, Klinikum Würzburg Mitte, Würzburg
,
R. Bals
 2   Pneumologie, Allergologie, Beatmungsmedizin, Universitätsklinikum des Saarlandes
,
M. Dreher
 3   Klinik für Pneumologie und Internistische Intensivmedizin, Medizinische Klinik V, Universitätsklinikum Aachen
,
M. Held
 4   Missioklinik, Klinikum Würzburg Mitte, Zentrum für Thoraxmedizin Würzburg, Medizinische Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin
,
L. Jany
 5   Psychologische Praxis, Würzburg
,
A. Rembert Koczulla
 6   Fachzentrum für Pneumologie, Schön Klinik Berchtesgadener Land, und Universitätsklinikum Marburg
,
M. Pfeifer
 7   Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg und Zentrum für Pneumologie, Klinik Donaustauf
,
W. Randerath
 8   Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien, Solingen
,
H. Watz
 9   Pneumologisches Forschungsinstitut an der LungenClinic Großhansdorf
,
H. Wilkens
10   Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg/Saar
,
G. Steinkamp
11   Medizinisch-wissenschaftliches Publizieren, Schwerin
› Author Affiliations
Further Information

Publication History

eingereicht15 April 2019

akzeptiert nach Revision28 July 2019

Publication Date:
09 September 2019 (online)

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Zusammenfassung

Pneumologen sollten immer auch an das Herz denken, wenn sie Patienten mit pulmonalen Erkrankungen diagnostizieren und therapieren. Dies gilt besonders für die COPD, aber auch eine ganze Reihe anderer pneumologischer Krankheitsbilder. Auf dem Workshop „Luftschlösser“, der wieder im Februar 2019 in Wiesbaden abgehalten wurde, diskutierten die Teilnehmer die vielfältigen Interaktionen von Lunge und Herz und deren Bedeutung für die Therapie. Ausgehend von pathophysiologischen Überlegungen wurden die psychosozialen Auswirkungen des Kardinalsymptoms Dyspnoe für Patienten sowohl mit Lungen- als auch Herzerkrankungen deutlich. Eine besondere diagnostische und therapeutische Herausforderung liegt im simultanen Auftreten von pulmonalen und kardialen Krankheiten beim individuellen Patienten. So wurde gezeigt, wie häufig die Komorbidität Herzinfarkt bei COPD übersehen wird – und vice versa. Dass auch Asthmatiker häufiger eine koronare Herzerkrankung oder eine Herzinsuffizienz aufweisen, ist im klinischen Alltag nicht immer präsent. Die Überblähung der Lunge beim Emphysem beeinträchtigt die kardiale Funktion auch beim Herzgesunden. Die medikamentöse Verminderung der Überblähung verbessert so die kardiale Funktion. Biomarker helfen bei der Differenzialdiagnose. Ihre Rolle wird in der großen deutschen Kohorte COSYCONET untersucht. Der schwerergradig herzkranke Lungenpatient stellt therapeutisch eine große Herausforderung dar, insbesondere wenn er intensiv- und beatmungspflichtig wird und das Weaning prolongiert verläuft. Ein „klassisches“ Beispiel der Interaktion von Lunge und Herz stellen die Lungengefäßerkrankungen dar. Sowohl bei der pulmonal-arteriellen Hypertonie als auch der chronisch-thromboembolischen pulmonalen Hypertonie vergeht nicht selten eine zu lange Zeit bis zur Diagnosestellung. Die therapeutischen Möglichkeiten haben sich für beide Gruppen von Lungengefäßerkrankungen in den letzten Jahren erheblich verbessert und stellen eine wichtige Aufgabe für Pneumologen dar. Schlafbezogene Atmungsstörungen und die kardiale Funktion stehen in einer Wechselbeziehung, die nach der SERVE-HF-Studie einer besonderen Aufmerksamkeit bedarf. Unstrittig bleibt, dass die obstruktive Schlafapnoe ein unabhängiger Risikofaktor für kardiovaskuläre Erkrankungen ist und leitlinienkonform behandelt werden muss.

Der Workshop zeigte eindrucksvoll die vielfältigen Wechselwirkungen von Herz und respiratorischem System, die zu Problemen in Diagnostik und Therapie führen können. Pneumologische Leitlinien sollten den Aspekt der kardialen Komorbidität stärker in den Fokus nehmen.

Abstract

When caring for patients with respiratory diseases, always think of the heart! This is especially important for COPD patients, but also for a variety of other disorders of the respiratory system. At the workshop “Luftschlösser”, held once more at Wiesbaden, Germany in February 2019 the many and important interactions of the lungs and the heart as well as the therapeutic implications were discussed. Based on pathophysiology, the psycho-social consequences of dyspnea, the leading symptom in patients with lung and heart disease became apparent. A particularly demanding diagnostic and therapeutic situation occurs in patients suffering simultaneously of lung and heart disease. It has been shown how frequently the diagnosis myocardial infarction is missed in COPD patients – and vice versa. Surprisingly, this is also the case in asthmatics with coronary heart disease or heart failure, a fact not readily known in clinical practice. In patients with emphysema and no apparent heart disease, hyperinflation leads to significantly restricted heart function. Reducing hyperinflation by inhaling broncholytics thus improves heart function. Biomarkers are increasingly being used for diagnostic purposes. Their role is being investigated in the large German COPD cohort COSYCONET. Lung patients suffering from more severe heart diseases pose a challenge for therapy in intensive care, especially when ventilated, and weaning from the ventilator is prolonged. Lung vessel diseases are “classic” examples of the intimate interaction of the lungs and the heart. In pulmonary arterial hypertension as well as in chronic thrombo-embolic pulmonary hypertension the lag time between the first symptoms and the definite diagnosis is often unacceptably long. For both diseases of the lung vessels therapeutic options have improved significantly over the last years. Pulmonologists should take care of this increasingly important patient group. Sleep-related breathing disorders and heart function are closely intertwined. Both conditions need special attention after the results of the SERVE-HF trial have been published. But there is no doubt that obstructive sleep apnea represents an independent and important risk factor for cardiovascular disease and needs to be treated according to existing guidelines.

This workshop demonstrated impressively the multiple interactions of the respiratory system with cardiac function, resulting diagnostic and therapeutic problems, and means to overcome these problems. Guidelines for respiratory diseases should appropriately address cardiac comorbidity.

* Sponsor: Boehringer Ingelheim Pharma GmbH & Co KG


 

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