Term Chronic Systemic Inflammatory Syndrome Should Be Added To COPD

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Main Category: COPD
Article Date: 01 Sep 2007 - 0:00 PDT

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COPD (chronic obstructive pulmonary disease) is no longer seen as a disease of just the lungs, according to a Viewpoint in The Lancet, special COPD edition. According to Professor Klaus Rabe, Leiden University Medical Centre, Leiden, Netherlands, and Dr Leonardo Fabbri, University of Modena and Reggio Emilia, Italy "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."

Skeletal muscle abnormalities are the most common comorbidities associated with COPD, as well as hypertension, diabetes, coronary artery disease, heart failure, cancer, lung infections and pulmonary vascular disease.

The writers tell us that chronic comorbid diseases affect COPD health outcomes. The majority of COPD patients who die do so as a result of non-respiratory disorders, such as cancer or cardiovascular disease.

For a diagnosis of chronic systemic inflammatory syndrome, the patient has to be over 40, a smoker for at least ten years (smoking at least a pack a day), have symptoms and abnormal lung function compatible with COPD, chronic heart failure, metabolic syndrome or increased reactive C-protein.

"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," the writers conclude.

From COPD to chronic systemic inflammatory syndrome?
Rabe, Leiden, Dr Leonardo Fabbri
The Lancet 2007; 370:797-799

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Written by: Christian Nordqvist
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