Towards a collaborative approach in chronic obstructive pulmonary disease: an expert opinion paper on cardiopulmonary risk reduction in clinical practice in Romania

Chronic obstructive pulmonary disease (COPD) is frequently complicated by cardiovascular diseases (CVDs), worsening patient outcomes. Recognising COPD as a multimorbid and syndemic condition, we developed this position paper to provide evidence-based recommendations for reducing cardiopulmonary (CP) risk through integrated, guideline-directed management in Romania. In June–September 2025, the multidisciplinary task force (pulmonologists/cardiologists/internal medicine specialists/general practitioners GPs), with expertise in diagnosis and treatment of patients with COPD and CVDs, engaged in working groups and developed algorithms for COPD management, focusing on CP risk reduction. Expert recommendations were formulated using current guidelines, scientific literature evidence and clinical expertise as follows: (i) prioritise early COPD diagnosis in at-risk populations; (ii) address CP risk assessment at every visit, with urgent pulmonology referral for severe COPD symptoms and cardiology referral for severe dyspnoea with abnormal electrocardiogram; (iii) ensure adequate assessment and management of mild-moderate COPD exacerbations, with urgent emergency referral/hospitalisation when severity cannot be reliably determined; (iv) refer all patients with severe COPD exacerbations to emergency care and/or hospitalisation; (v) implement standardised COPD hospital discharge protocol; (vi) optimise pharmacotherapy by initiating long-acting β₂-agonist (LABA) + long-acting muscarinic antagonist (LAMA) and escalating to triple therapy (LABA/LAMA/inhaled corticosteroid) when indicated and ensure structured follow-up as per GOLD guidelines. This expert opinion paper calls for urgent action to bridge the gap between guideline-directed recommendations and routine practice, with a strict policy of zero tolerance for treatment delays.