Towards a collaborative approach in chronic obstructive pulmonary disease: an expert opinion paper on cardiopulmonary risk reduction in clinical practice in Romania
References
- Fabbri LM, Celli BR, Agustí A, Criner GJ, Dransfield MT, Divo M, et al. COPD and multimorbidity: recognising and addressing a syndemic occurrence. The Lancet Respiratory Medicine. 2023;11: 1020–1034. doi:10.1016/S2213-2600(23)00261-8
- Boers E, Barrett M, Su JG, Benjafield AV, Sinha S, Kaye L, et al. Global burden of chronic obstructive pulmonary disease through 2050. JAMA Network Open. 2023;6: e2346598. doi:10.1001/jamanetworkopen.2023.46598
- Benjafield A, Tellez D, Barrett M, Gondalia R, Nunez C, Wedzicha J, et al. An estimate of the European prevalence of COPD in 2050. European Respiratory Journal. 2021;58: OA2866.
- Mihălţan F, Nemes R, Daramus I, Paunescu B, Farcasanu D. Prevalence of chronic obstructive pulmonary disease (COPD) in Romania. Chest. 2012;142: 658A. doi:10.1378/chest.1389539
- Duszyk K, McLoughlin RF, Gibson PG, McDonald VM. The use of treatable traits to address COPD complexity and heterogeneity and to inform the care. Breathe (Sheffield, England). 2021;17: 210118. doi:10.1183/20734735.0118-2021
- Morgan AD, Zakeri R, Quint JK. Defining the relationship between COPD and CVD: what are the implications for clinical practice? Therapeutic Advances in Respiratory Disease. 2018;12: 1753465817750524. doi:10.1177/1753465817750524
- Hawkins NM, Kaplan A, Ko DT, Penz E, Mohit Bhutani M. Is ‘Cardiopulmonary’ the new ‘Cardiometabolic’? making a case for systems change in COPD. Pulmonary therapy. 2024;10: 363–376. doi:10.1007/s41030-024-00270-2
- Singh D, Han MK, Hawkins NM, Hurst JR, Kocks JWH, Skolnik N. Implications of cardiopulmonary risk for the management of COPD: a narrative review. Advances in Therapy. 2024;41: 2151–2167. doi:10.1007/s12325-024-02855-4
- Global initiative for chronic obstructive lung disease (GOLD) 2025 report. Available from: https://goldcopd.org/2025-gold-report/[Accessed June 2025].
- Global initiative for chronic obstructive lung disease (GOLD) 2026 report. Available from: https://goldcopd.org/2026-gold-report-and-pocket-guide/[Accessed November 2025].
- de Miguel-Díez J, Núñez Villota J, Santos Pérez S, Manito Lorite N, Alcázar Navarrete B, Delgado Jiménez JF, et al. Multidisciplinary management of patients with chronic obstructive pulmonary disease and cardiovascular disease. Archivos de Bronconeumologia. 2024;60: 226–237. doi:10.1016/j.arbres.2024.01.013
- Hurst JR, Gale CP. MACE in COPD: addressing cardiopulmonary risk. The Lancet Respiratory Medicine. 2024;12: 345–348. doi:10.1016/S2213-2600(24)00038-9
- Bourbeau J, Bhutani M, Hernandez P, Aaron SD, Beauchesne M-F, Kermelly SB, et al. 2023 Canadian Thoracic Society Guideline on pharmacotherapy in patients with stable COPD. Chest. 2023;164: 1159–1183. doi:10.1016/j.chest.2023.08.014
- Shrikrishna D, Taylor CJ, Stonham C, Gale CP. Exacerbating the burden of cardiovascular disease: how can we address cardiopulmonary risk in individuals with chronic obstructive pulmonary disease? European Heart Journal. 2024;45: 247–249. doi:10.1093/eurheartj/ehad669
- Martinez FJ, Rabe KF, Ferguson GT, Wedzicha JA, Singh D, Wang C. Reduced all-cause mortality in the ETHOS trial of budesonide/glycopyrrolate/formoterol for Chronic obstructive pulmonary disease. A randomized, double-blind, multicenter, parallel-group study. American Journal of Respiratory and Critical Care Medicine. 2021;203: 553–564. doi:10.1164/rccm.202006-2618OC
- Wells JM, Criner GJ, Halpin DMG, Han MK, Jain R, Lange P, et al. Mortality Risk and Serious Cardiopulmonary Events in Moderate-to-Severe COPD: Post Hoc Analysis of the IMPACT Trial. Chronic Obstr Pulm Dis. 2023; 10(1): 33–45. doi: 10.15326/jcopdf.2022.0332
- Stolz D, Mkorombindo T, Schumann DM, Agusti A, Ash SY, Bafadhel M. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet. 2022;400: 921–972. doi:10.1016/S0140-6736(22)01273-9
- Gale CP, Hurst JR, Hawkins NM, Bourbeau J, Han MLK, Lam CSP, et al. Identification and management of cardiopulmonary risk in patients with COPD: a multidisciplinary consensus and modified Delphi study. European Journal of Preventive Cardiology. 2025;32(15): 1445–1460. doi:10.1093/eurjpc/zwaf119
- Rabe KF, Hurst JR, Suissa S. Cardiovascular disease and COPD: dangerous liaisons? European Respiratory Review. 2018;27(149): 180057. doi:10.1183/16000617.0057-2018
- Rogliani P, Ritondo BL, Laitano R, Chetta A, Calzetta L. Advances in understanding of mechanisms related to increased cardiovascular risk in COPD. Expert Review of Respiratory Medicine. 2021;15: 59–70. doi:10.1080/17476348.2021.1840982
- Jankowski P, Mycroft K, Górska K, Korczyński P, Krenke R. How to enhance the diagnosis of early stages of chronic obstructive pulmonary disease (COPD)? The role of mobile spirometry in COPD screening and diagnosis-a systematic review. Advances in Respiratory Medicine. 2024;92: 158–174. doi:10.3390/arm92020018
- QRISK 3 score. Available form: QRISK.org [Accessed October 2025].
- SCORE2 Working Group and ESC Cardiovascular Risk Collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. European Heart Journal. 2021;42: 2439–2454. doi:10.1093/eurheartj/ehab309
- Amegadzie JE, Gao Z, Quint JK, Russell R, Hurst JR, Lee TY, et al. QRISK3 underestimates the risk of cardiovascular events in patients with COPD. Thorax. 2024;79: 718–724. doi:10.1136/thorax-2023-220615
- Fawzy A, Vogelmeier CF. Standard risk scores inadequately estimate subclinical Coronary artery disease in Chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 2025;211: 889–890. doi:10.1164/rccm.202411-2240ED
- Zhou L, Yang H, Zhang Y, Wang Y, Zhou X, Liu T. Predictive value of lung function measures for cardiovascular risk: a large prospective cohort study. Thorax. 2024;79: 250–258. doi:10.1136/thorax-2023-220703
- Jones P, Alzaabi A, Casas Herrera A, Polatli M, Rabahi MF, Telles AC. Understanding the gaps in the reporting of COPD exacerbations by patients: a review. COPD. 2024;21: 2316594. doi:10.1080/15412555.2024.2316594
- Calabria S, Ronconi G, Dondi L, Dondi L, Dell’Anno I, Nordon C, et al. Cardiovascular events after exacerbations of chronic obstructive pulmonary disease: results from the EXAcerbations of COPD and their OutcomeS in CardioVascular diseases study in Italy. European Journal of Internal Medicine. 2024;127: 97–104. doi:10.1016/j.ejim.2024.04.021
- Hawkins NM, Nordon C, Rhodes K, Talukdar M, McMullen S, Ekwaru P, et al. Heightened long-term cardiovascular risks after exacerbation of chronic obstructive pulmonary disease. Heart. 2024;110: 702–709. doi:10.1136/heartjnl-2023-323487
- Nordon C, Simons SO, Marshall J, Müllerová H, Pollack M, Bengtsson C, et al. The sustained increase of cardiovascular risk following COPD exacerbations: meta-analyses of the EXACOS-CV studies. ERJ Open Research. 2025;11(3): 01091–2024. doi:10.1183/23120541.01091-2024
- Miravitlles M, Bhutani M, Hurst JR, Franssen FME, van Boven JFM, Khoo EM. Implementing an evidence-based COPD hospital discharge protocol: a narrative review and expert recommendations. Advances in Therapy. 2023;40: 4236–4263. doi:10.1007/s12325-023-02609-8
- Lindh A, Giezeman M, Theander K, Zakrisson A-B, Westerdahl E, Stridsman C. Factors associated with patient education in patients with Chronic obstructive pulmonary disease (COPD) - A primary health care register-based Study. International Journal of Chronic Obstructive Pulmonary Disease. 2024;19: 1069–1077. doi:10.2147/COPD.S455080
- Diab N, Gershon AS, Sin DD, Tan WC, Bourbeau J, Boulet LP, et al. Underdiagnosis and overdiagnosis of Chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 2018;198: 1130–1139. doi:10.1164/rccm.201804-0621CI
- Guecamburu M, Klein E, Verdy G, Nocent-Ejnaini C, Macey J, Portel L, et al. Factors associated with undiagnosed COPD in patients hospitalised for severe COPD exacerbation. BMJ Open Respiratory Research. 2024;11(1): e002620. doi:10.1136/bmjresp-2024-002620
- Singh D, Holmes S, Adams C, Bafadhel M, Hurst JR. Overcoming therapeutic inertia to reduce the risk of COPD exacerbations: four action points for healthcare professionals. International Journal of Chronic Obstructive Pulmonary Disease. 2021;16: 3009–3016. doi:10.2147/COPD.S329316
Language: English
Page range: 20 - 28
Published on: Apr 4, 2026
Published by: Romanian Society of Pneumology
In partnership with: Paradigm Publishing Services
Publication frequency: Volume open
Keywords:
Related subjects:
© 2026 Florin-Dumitru Mihălțan, Ștefan Dumitrache-Rujinski, Oana Gheorghe-Fronea, Cristina Isar, Daniel Lighezan, Florin Mitu, Camelia Nicolae, Cătălina Panaitescu, Ruxandra-Mioara Râjnoveanu, Claudia Lucia Toma, Ana-Maria Vintilă, published by Romanian Society of Pneumology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.