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Indeed respiratory infections and\/or air pollution are the main causes of <jats:styled-content style=\"fixed-case\">ECOPD<\/jats:styled-content>. They cause an acute inflammation of the airways and the lung on top of the chronic inflammation that is associated with <jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>. This acute inflammation is responsible of the development of acute respiratory symptoms (in these cases the term <jats:styled-content style=\"fixed-case\">ECOPD<\/jats:styled-content> is appropriate). However, the acute inflammation caused by infections\/pollutants is almost associated with systemic inflammation, that may cause acute respiratory symptoms through decompensation of concomitant chronic diseases (eg acute heart failure, thromboembolism, etc) almost invariably associated with <jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>. Most concomitant chronic diseases share with <jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content> 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. For this reason, in patients with multi\u2010morbidity (eg <jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content> with chronic heart failure and hypertension, etc), the exacerbation of respiratory symptoms may be particularly difficult to investigate, as it may be caused by exacerbation of <jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content> and\/or \u2265 comorbidity, (e.g. decompensated heart failure, arrhythmias, thromboembolisms) without necessarily involving the airways and lung. In these cases the term <jats:styled-content style=\"fixed-case\">ECOPD<\/jats:styled-content> is inappropriate and misleading.<\/jats:p>","DOI":"10.1111\/eci.12064","type":"journal-article","created":{"date-parts":[[2013,2,11]],"date-time":"2013-02-11T12:42:37Z","timestamp":1360586557000},"page":"510-521","source":"Crossref","is-referenced-by-count":39,"title":["Mechanisms of acute exacerbation of respiratory symptoms in chronic obstructive pulmonary disease"],"prefix":"10.1111","volume":"43","author":[{"given":"Mihai","family":"Roca","sequence":"first","affiliation":[{"name":"Section of Respiratory Diseases Department of Oncology, Haematology and Respiratory Diseases University of Modena and Reggio Emilia Modena Italy"},{"name":"Faculty of Medicine Department of Pneumology \u201cGrigore T. 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