Symptom dynamics in chronic obstructive pulmonary disease and chronic heart failure: A comprehensive clinical and methodological exploration

Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are progressive conditions that frequently co-occur due to shared risk factors like smoking. Both conditions involve sudden symptom flare-ups – acute exacerbations of COPD (AECOPD) and acute heart failure (AHF) – and these episodes are difficult to distinguish because symptoms, mainly shortness of breath, overlap. Despite this clinical complexity, healthcare systems still tend to manage COPD and CHF separately. This thesis addresses the COPD-CHF interaction in daily life, differentiation AECOPD and AHF, and how technology can support personalized care.

Using daily symptom data from international cohort studies, the research shows that deterioration of COPD- and CHF-related symptoms often occur at the same time. Although the severity and timing differed substantially across individuals, the overarching pattern was consistent: COPD and CHF do not behave as independent diseases. Their symptoms influence one another, highlighting the limitations of single-disease guidelines for people living with both conditions.

A key challenge is distinguishing AECOPD from AHF in practice. A systematic review found that only a few biomarkers show limited usefulness, and even these must be interpreted cautiously and in context. The scarcity of evidence underscores the need for better diagnostic tools to support clinical decision-making.

The thesis also examines the temporal relationships between symptoms. Advanced statistical modeling revealed a bidirectional pattern: worsening heart failure symptoms often preceded COPD worsening the next day, and vice versa. However, these dynamics varied widely across patients, with many showing stronger effects of COPD deterioration on CHF than the reverse. Such heterogeneity illustrates why standardized care pathways fall short and supports the need for individualized management.

Technological innovations provide promising solutions. Remote monitoring enabled daily symptom tracking, and visualizing these patterns could help recognizing trends and triggers. Interviews with patients and their healthcare professionals indicated that visual tools could foster better communication, decision-making, and self-management.

Overall, the thesis emphasizes the intertwined nature of COPD and CHF, the diagnostic and clinical challenges posed by overlapping symptoms, and the potential of technology to improve integrated, patient-centered disease management.