Egypt’s expert consensus on chronic obstructive pulmonary disease with co-existing cardiovascular disease: mechanism, screening, and management

Abstract Background Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition that frequently coexists with cardiovascular diseases (CVDs). They share risk factors, overlapping clinical manifestations, and bidirectional pathophysiological interactions contributing to increased morbidity and mortality. Cardiovascular disease and cardiovascular risk are often underrecognized in patients with COPD, while COPD may likewise remain undiagnosed in patients with established CVD. This Egyptian expert consensus aimed to develop practical recommendations for identifying and managing COPD in patients with established or suspected CVD. It also emphasized bidirectional screening, recognition of cardiopulmonary interactions, pharmacological treatment, exacerbation prevention, and integrated multidisciplinary care. Methods A modified Delphi approach was used to develop 45 consensus statements on COPD–CVD overlap. An 18-member expert group, comprising 14 pulmonologists and 4 cardiologists, included a four-member steering committee responsible for the literature review and initial statement development. The statements were discussed and refined during a face-to-face meeting in January 2025, followed by one anonymous electronic voting round among the 14-member voting panel using a five-point Likert scale. Consensus was defined as at least 70% agreement. Results The consensus included 45 statements. The voting results demonstrated very strong agreement (≥ 90%) in 42 (93.3%) of the statements, strong agreement (≥ 75% to < 90%) in two statements (4.44%), and moderate agreement (70% to < 75%) in one statement (2.22%). Conclusions Current consensus indicates that COPD and CVD are closely interconnected conditions that require coordinated cardiopulmonary assessment instead of isolated disease management. The consensus highlighted bidirectional case-finding, cardiovascular risk assessment in COPD, recognition of cardiovascular disease in patients with respiratory symptoms, exacerbation prevention, and multidisciplinary care. Management should remain individualized according to respiratory phenotype, cardiovascular status, exacerbation risk, and other clinically relevant comorbidities.