{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:11:50Z","timestamp":1791619910548,"version":"4.3.4"},"reference-count":66,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2011,3,23]],"date-time":"2011-03-23T00:00:00Z","timestamp":1300838400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Respir Dis"],"published-print":{"date-parts":[[2011,6]]},"abstract":"<jats:p>Chronic obstructive pulmonary disease (COPD) has traditionally been considered a disease of the lungs secondary to cigarette smoking and characterized by airflow obstruction due to abnormalities of both airway (bronchitis) and lung parenchyma (emphysema). It is now well known that COPD is associated with significant systemic abnormalities, such as renal and hormonal abnormalities, malnutrition, muscle wasting, osteoporosis, and anemia. However, it is still unclear whether they represent consequences of the pulmonary disorder, or whether COPD should be considered as a systemic disease. These systemic abnormalities have been attributed to an increased level of systemic inflammation. Chronic inflammation, however, may not be the only cause of the systemic effects of COPD. Recent data from humans and animal models support the view that emphysema may be a vascular disease. Other studies have highlighted the role of repair failure, bone marrow abnormality, genetic and epigenetic factors, immunological disorders and infections as potential causes of COPD systemic manifestations. Based on this new evidence, it is reasonable to consider COPD, and emphysema in particular, as \u2018a disease with a significant systemic component\u2019 if not a \u2018systemic disease\u2019 per se. The aim of this review is to give an overview of the most relevant and innovative hypothesis about the extrapulmonary manifestations of COPD.<\/jats:p>","DOI":"10.1177\/1753465811400490","type":"journal-article","created":{"date-parts":[[2011,3,23]],"date-time":"2011-03-23T21:09:58Z","timestamp":1300914598000},"page":"217-224","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":80,"title":["COPD: a multifactorial systemic disease"],"prefix":"10.1177","volume":"5","author":[{"given":"Alice","family":"Huertas","sequence":"first","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy INSERM U999 \u201cPulmonary Hypertension: Pathophysiology and Novel Therapies\u201d Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; University Paris-Sud 11, Orsay, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Palange","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy INSERM U999 \u201cPulmonary Hypertension: Pathophysiology and Novel Therapies\u201d Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; University Paris-Sud 11, Orsay, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2011,3,23]]},"reference":[{"key":"bibr1-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.03.00405703"},{"key":"bibr2-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1080\/15412550801941349"},{"key":"bibr3-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00128008"},{"key":"bibr4-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1038\/nrm1493"},{"key":"bibr5-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1378\/chest.121.2.609"},{"key":"bibr6-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200406-754OC"},{"key":"bibr7-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1038\/380435a0"},{"key":"bibr8-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.04.00014304"},{"key":"bibr9-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.715847"},{"key":"bibr10-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.161.3.9808075"},{"key":"bibr11-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1378\/chest.130.5.1326"},{"key":"bibr12-1753465811400490","doi-asserted-by":"crossref","unstructured":"Crothers, K., Huang, L., Goulet, J.L., Goetz, M.B., Brown, S., Rodriguez-Barradas, M.\n                      et al.\n                      (2011) HIV infection and risk for incident pulmonary diseases in the combination antiretroviral therapy era.\n                      Am J Respir Crit Care Med\n                      183: 388\u2013395.","DOI":"10.1164\/rccm.201006-0836OC"},{"key":"bibr13-1753465811400490","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-132-5-200003070-00006"},{"key":"bibr14-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1634\/stemcells.2005-0440"},{"key":"bibr15-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2003.019588"},{"key":"bibr16-1753465811400490","first-page":"697","volume":"48","author":"Ghamra Z.","year":"2003","journal-title":"Respir Care"},{"key":"bibr17-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1165\/rcmb.2004-0008OC"},{"key":"bibr18-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.153.3.8630580"},{"key":"bibr19-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.04.00143703"},{"key":"bibr20-1753465811400490","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbrc.2005.01.095"},{"key":"bibr21-1753465811400490","doi-asserted-by":"crossref","unstructured":"Huertas, A. and Palange, P. 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