In recent years several studies have addressed the issue regarding the systemic impact in patients with chronic obstructive pulmonary disease (COPD). Most epidemiologic studies have investigated the comorbidities of COPD and reported the invariably present association between COPD and cardiovascular and metabolic diseases. This evidence is bringing the scientific community to the suggestion that the term “multimorbidity” better reflects these conditions, as they develop simultaneously in response to shared risk factors (i.e. smoking, ageing, pollution, alcohol, inactivity, nutrition).

Interestingly, during acute exacerbation of COPD, the worsening of respiratory symptoms due to the increased level of inflammation may be both associated to the acute inflammation of the airways and/or to the decompensation of concomitant chronic diseases (eg acute heart failure, thromboembolism, etc) following the increased systemic inflammatory process. Indeed, most concomitant chronic diseases share with COPD not only the underlying chronic inflammation of the target organs (i.e. lungs, myocardium, vessels, adipose tissue), but also clinical manifestations like fatigue and dyspnoea.

Finally, even treatment of COPD patients might be targeted not only at optimizing bronchodilation and reducing the lung inflammation, but also at reducing risk factors for systemic involvement and treating appropriately each single concomitant condition and the whole individual function by the rehabilitative approach.

We are particularly interested in articles describing this clinical entity in the medical ground, characterizing the COPD as a multifaceted disease, focusing at new insights both in term of epidemiology, biological mechanisms and translating research regarding comorbidities in COPD phenotyping, clinical features, response to both pharmachological and non-pharmacological therapies or strategies. Potential topics include, but are not limited to:

• Epidemiology of comorbidities in the COPD population
• Basic mechanisms of lung and systemic inflammation
• Biomarkers of inflammation in COPD with comorbidities
• Muscle dysfunction associated with COPD
• Phenotypes and clusters of comorbidities in the chronic complex disease
• Assessment of symptoms and clinical feature in the complex COPD patient
• Impact of respiratory drugs in the complex COPD patient
• Effectiveness of rehabilitation in COPD with comorbidities

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