Chronic Obstructive Pulmonary Disease and Atrial Fibrillation

An Interdisciplinary Perspective

Sami O. Simons; Adrian Elliott; Manuel Sastry; Jeroen M. Hendriks; Michael Arzt; Michiel Rienstra; Jonathan M. Kalman; Hein Heidbuchel; Stanley Nattel; Geertjan Wesseling; Ulrich Schotten; Isabelle C. van Gelder; Frits M.E. Franssen; Prashanthan Sanders; Harry J.G.M. Crijns; Dominik Linz


Eur Heart J. 2021;42(5):532-540. 

In This Article

Assessment and Diagnosis of Chronic Obstructive Pulmonary Disease in Atrial Fibrillation Patients

Screening and diagnostic tools are summarized in Table 1. Chronic obstructive pulmonary disease should be suspected in everyone with typical respiratory symptoms (e.g. dyspnoea, cough, wheezing, and sputum production) and a history of smoking.[39] Spirometry is the cornerstone for the diagnosis of COPD.[39] Chronic obstructive pulmonary disease is present if the ratio of forced expiratory volume in 1 s and forced vital capacity (FEV1/FVC) is below 0.70 after the inhalation of a bronchodilator. The handheld microspirometer is mainly used as a tool to exclude COPD; if the ratio of forced expiratory volume in 1 s and the forced volume in 6 s is above 0.73, COPD is unlikely.[40] A recent meta-analysis showed that single questionnaires lack specificity and stand-alone handheld microspirometry lacks sensitivity.[40] A staged approach using both questionnaires (such as the COPD Diagnostic Questionnaire) followed by a handheld microspirometry might be the best diagnostic approach with a sensitivity and specificity of 72% and 97%, respectively.[41] Abnormal handheld microspirometry results should always be followed by a conventional pulmonary work-up, including standard spirometry and body plethysmography to detect both airway obstruction as well as hyperinflation.