COPD can no longer be judged as only a disease of the lungs

Aug 30 2007

Chronic Obstructive Pulmonary Disease (COPD) can no longer be judged as only a disease of the lungs, say authors of a Viewpoint in this week's COPD special edition of The Lancet.

Professor Klaus Rabe,Leiden University Medical Centre, Leiden, Netherlands, and Dr Leonardo Fabbri, University of Modena and Reggio Emilia, Italy, say: "We propose to add the term chronic systemic inflammatory syndrome to the diagnosis of COPD to stimulate discussion around the frequent complex chronic comorbidities in people with COPD and to provoke a new view of the disease in general."

The most common comorbidities associated with COPD are skeletal muscle abnormalities, high blood pressure, diabetes, coronary artery disease, heart failure, lung infections, cancer, and pulmonary vascular disease. The authors say: "Chronic comorbid diseases affect health outcomes in COPD; in fact patients with COPD mainly die of non-respiratory disorders such as cardiovascular disease or cancer."

To be diagnosed with chronic systemic inflammatory syndrome, a patient would need to have three of the following diagnostic components: aged over 40 years; smoking for more than 10 pack-years*; symptoms and abnormal lung function compatible with COPD,; chronic heart failure; metabolic syndrome; or increased reactive C-protein.

The authors conclude: "Clinical practice guidelines in general seem to ignore the fact that most patients with a chronic disease have additional comorbidities. Guidelines designed largely by speciality-dominated committees for management of individual diseases provide clinicians with little advice for caring for people with several chronic diseases, resulting in poly-pharmacia. We suggest that the introduction of an overarching idea such as chronic systemic inflammatory syndrome will improve recognition of chronic comorbid disorders and will affect patients' care, particularly that of elderly people. Not only will clinicians have to agree to change their approach, to treating chronic diseases but also our health-care system must rise to this major challenge."