Addressing Cardiopulmonary Risk in COPD: A Multidisciplinary Expert Opinion Framework for the United States Healthcare System

Stephen Brunton,1 Patrick A Cambier,2,* Nathaniel Marchetti,3,* Joel Solis4,*1US Primary Care Respiratory Group, Winnsboro, SC, USA; 2Interventional Cardiac Consultants, Tampa, FL, USA; 3Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine Temple University, Philadelphia, PA, USA; 4Valley Medical Arts Clinic, McAllen, TX, USA*These authors contributed equally to this workCorrespondence: Stephen Brunton, US Primary Care Respiratory Group, 608 Wateree Key Court, Winnsboro, SC, 29180, USA, Email ozdoc@aol.comAbstract: Chronic obstructive pulmonary disease (COPD) is a prevalent and devastating condition responsible for substantial morbidity and mortality in the United States (US). Although the burden of cardiopulmonary (CP) comorbidity in COPD is increasingly known, CP risk remains frequently under-recognized and suboptimally managed in routine clinical practice. Definitions of CP risk in COPD vary across the literature and clinical settings. CP risk may be broadly defined as the risk of serious respiratory and/or cardiovascular events in patients with COPD, including COPD exacerbations, myocardial infarction, stroke, heart failure decompensation, arrhythmia, and death. While current clinical guidelines recognize comorbidity, there remain no clear protocols for screening, risk assessment, or a coordinated multidisciplinary approach to address the CP risk in patients with COPD. To address these gaps, a multidisciplinary expert panel developed consensus-based guidance through an iterative process incorporating an expert-led narrative review supported by targeted desk searches alongside multiple rounds of expert input. This paper identifies critical gaps in the management of CP risk among patients with COPD in the US and outlines actionable steps towards improvement of care. Actionable recommendations include encouraging earlier screening and risk assessment to identify patients at risk of exacerbations and improving patient access to multidisciplinary teams, prompting earlier initiation or optimization of evidence-based treatment. Furthermore, implementation of fully coordinated treatment strategies through primary care settings and increasing the use of preventative strategies in the clinic such as spirometry, vaccination, and smoking cessation are recommended. By shifting to proactive, multidisciplinary care, healthcare practitioners can better address the complex needs of patients with COPD to reduce their CP risk and improve individual and population-level outcomes.Keywords: cardiovascular diseases, pulmonary disease, comorbidity, exacerbations