**7. Heart disease**

Classically, the chronic forms of valvular heart disease could present with airflow obstruction and / or reduction in DLCO. The decrease in the incidence of rheumatic fever and development of new cardiac diagnostic methods avoid this situation as a common

subjects over 60 years of age have been described. It is important the determination of the

Heterozygous individuals have a higher susceptibility to develop COPD in the presence of smoking or cigarrete exposure, and should be detected for a better affiliation of the syndrome. Therefore, measurement of alpha-1-antitrypsin should be practiced at least once

Although Tuberculosis is considered as precursor in pulmonary specialty, airflow obstruction in pulmonary tuberculosis has been just considered few years ago. (Figure 1). In 1971, Snider et al had described Obstructive airway disease and pulmonary tuberculosis, and PLATINO study in Latin America has been updated this. In an environment where tuberculosis is or was common, the sequelae of tuberculosis are a major cause of chronic airflow obstruction in individuals who have never been smokers. Airway obstruction in

do not correlate with the degree of the affected area, could coexist even if area of

Problems in the differential diagnosis of bronchial asthma not reversible and COPD are well

It is accepted that 30% of asthmatic patients are smokers, and this variant of overlap syndrome has been well described by various authors. There is evidence that smokers with asthma are more resistant to treatment. The natural history of patients with COPD asthmic syndrome involves a fast loss of FEV1; they have a decreased life expectancy, though this aspect is not

In the population over 80 or more years old, up to 50% of individuals may have a FEV1/FVC <70%. Although some analogies between COPD and elderly have already been highlighted, further studies are required. Hence tables with normal spirometric values for the elderly have just been available recently. Nevertheless, the presence of a FEV1/FVC <70% is clinical data that should not be neglected, because there has been a marker of

Classically, the chronic forms of valvular heart disease could present with airflow obstruction and / or reduction in DLCO. The decrease in the incidence of rheumatic fever and development of new cardiac diagnostic methods avoid this situation as a common

well known because many studies included as non-smokers and former smokers.

is presented in patients with treated pulmonary tuberculosis even healthy subjects

DLCO for evaluation of its prognosis and outcome, not only spirometry.

in all patients with chronic airflow obstruction.

**4. COPD syndrome by tuberculosis** 

pulmonary tuberculosis:

damage is small

known.

**6. Aging** 

**7. Heart disease** 

 is unusual progresses and is irreversible to bronchodilator.

**5. Asthma chronic non-reversible perennial** 

reduced life expectancy, even in old age.

Fig. 1. A 55-year old woman, nonsmoker, was seen as outpatient in a check-up, a spirometry revealed the presence of obstructive patterns. A diagnosis of Pulmonary Tuberculosis had been made 25 year ago and antituberculosis treatment was completed. Diagnosis: sequelae of tuberculosis.

problem of differential diagnosis. The comorbidity of COPD and heart failure caused by smoking, metabolic syndrome, the syndrome of obstructive sleep apnea and aging, could hinder the diagnosis of COPD exacerbation vs heart failure. However, measurement of the natriuretic peptide can help in the differential diagnosis. Once patients have been discharged from hospital, they should be required to filial the impact of both processes. Studio ergometer should be made in outpatients in stable phase, although this is done in rare occasions.
