From COPD to chronic systemic inflammatory syndrome?

Chronic obstructive pulmonary disease (COPD) is characterised by poorly reversible airflow limitation that is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, particularly cigarette smoke.1 A diagnosis of COPD should be considered in any current or previous smoker older than 40 years who has symptoms of cough, sputum production, or dyspnoea.1 Diagnosis and assessment of severity of COPD are based on the degree of airflow limitation at spirometry.1 However, increasing evidence suggests that clinical features of COPD and airflow limitation are poorly correlated and a comprehensive approach, including imaging2 and assessment of exercise tolerance and body-mass index,3 is needed. In this Viewpoint, we aim to convey the message that COPD can no longer be judged a disease only of the lungs. 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.