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COPD and Congestive Heart Failure - How to Tell the Difference

Last updated: June 2023

COPD and Congestive Heart Failure (CHF for short) are two of the most common chronic health conditions and also among the top 3 leading causes of death in the U.S. Here's the scoop - they are often connected. That's right. People who have COPD have a 20% or greater risk for developing CHF and CHF is a leading cause of death in people with COPD.1 It's also important to note that the two conditions often have very similar signs and symptoms, so it can be hard to tell them apart.

What is congestive heart failure?

Despite the name of this condition, CHF does not mean your heart has actually failed to work altogether. Rather, it is failing to work well. When the heart becomes too weak to pump the blood out to the body effectively, we call it heart failure. Because of this inefficient pumping, fluid starts to back up in the heart and lungs, and eventually in the lower legs.2 That makes the heart and lungs have to work even harder, with less effective results.

How are CHF and COPD related?

Although these are two separate conditions, each of which can exist without the other, there are similarities. Let's take a closer look at the ways COPD and CHF are alike, and also how they are different.

They have similar symptoms

Both COPD and CHF can cause shortness of breath, coughing, and wheezing. In both conditions, the shortness of breath is usually more pronounced during activity than it is at rest. One difference is that although chest tightness is a common symptom of COPD, it does not usually occur with CHF. However, those who have heart failure may notice their heart beating irregularly or rapidly.3 Although wheezing is common with both COPD and CHF, with heart failure, a health care professional may hear a "crackle" or what is called rales in the lungs when listening through a stethoscope. This is the sound of the air you breathe moving through the fluid in your lungs.

Both are chronic and have periodic flare-ups

Each of these conditions is chronic and cannot be cured. But you can have periods of relative stability when symptoms are not too bothersome. At times, though, the symptoms can worsen or flare-up. This is called an exacerbation.

The difference is what causes these exacerbations. With COPD, triggers are often environmentally-related:

  • Exposure to germs that cause respiratory infections
  • Breathing in cold dry air
  • Exposure to air pollution
  • Inhaling strong fumes or smoke

With CHF, factors that cause flare-ups are often more related to lifestyle or other health issues.

  • Eating the wrong foods, for example, too many salty foods
  • Drinking too much water (fluid intake is usually restricted with heart failure)
  • Having a heart attack or stroke

In both cases, exacerbations can also occur when medications are not taken as prescribed.

The underlying causes of COPD and CHF are often different

The most common risk factor for COPD is tobacco smoking.3 There can be other causes as well, including workplace exposure to fumes or other toxic substances and certain genetic factors. But smoking is the most common.

Smoking is also a risk factor for heart disease, including CHF. In addition, coronary artery disease, where heart vessels become partially blocked, can also result in heart failure, as can high blood pressure and heart valve problems.3

COPD and CHF often occur together

Experts are not entirely sure exactly why people with COPD can also have heart failure. But as mentioned earlier, the lung damage from COPD does place extra stress on the heart. In the end, both conditions result in respiratory symptoms. When they occur together, studies show that the risk of negative outcomes is much increased4

How do you know which is which?

Unfortunately, because the symptoms are so similar, it's hard for you to know which condition you might be experiencing, or which one is causing your symptoms to worsen. This is why you'll need the advice of your doctor. The doctor will perform a physical exam to detect uniquely-CHF symptoms such as rales or leg swelling. They may also look for heart rhythm irregularities or swelling of the neck veins. Chest x-rays, echocardiograms, and certain blood tests can also be used to detect CHF.

What difference does it make?

If possible, your doctor will want to determine which disease may be causing your symptoms to occur or to worsen, because the treatments for each are quite different.

COPD treatment

COPD treatment is aimed at helping your airways function better. Bronchodilators are used to treat COPD because they relax the airway muscles and make breathing easier. Some bronchodilators are short-acting, while others exert an influence over a longer period of time. Both types may be used. Inhaled steroids are sometimes prescribed, as well, to reduce inflammation in the airways.3 Supplemental oxygen may also be used, if necessary.

CHF treatment

CHF treatment is aimed at decreasing the workload on the heart and may require the use of a number of types of medicines, such as:

  • Vasodilators, to widen blood vessels and lower blood pressure
  • Beta blockers, to lower the heart rate and lessen the work on the heart
  • Diuretics, to remove fluid and sodium from your body, which also lowers blood pressure
  • Digoxin, to help regulate your heart rhythm
  • Anticoagulants, to reduce the risk of blood clots

Supplemental oxygen is also useful in some cases with CHF.

A combined approach may be needed

When you have both COPD and CHF, it may be tough for the doctor to figure out which disease is causing the problems. So it may make sense to treat both at the same time, using many of the methods outlined above.

Follow your treatment plan

Both COPD and CHF are serious chronic conditions that can affect your breathing and your quality of life. They are similar in terms of symptoms and outlook, and many patients do suffer from both conditions. While they can occur independently, it's important to understand how they are connected too.

Your best bet if you have both COPD and CHF is to follow your treatment plans to the best of your ability, practice a healthy lifestyle, and keep in close contact with your health care team. All of those things can help prevent exacerbations. Plus, take action right away if you start to notice your symptoms worsening at all or if new symptoms arise. That can help flare-ups from spiraling out of control.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The COPD.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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