Agustí A G
Institut de Medicina Respiratoria, Hospital Universitari Son Dureta, Andrea Doria 55, 07014 Palma de Mallorca, Spain.
Novartis Found Symp. 2001;234:242-9; discussion 250-4.
Traditionally, chronic obstructive pulmonary disease (COPD) has been understood as a disease of the lungs, characterized by irreversible airflow limitation due to chronic bronchitis and/or emphysema. The latter are thought mainly to be the consequence of an excessive inflammatory response to tobacco smoking. Recently, several studies have shown that this pulmonary inflammation may also be detected in the systemic circulation, and that this systemic inflammation may have important clinical consequences. Most prominent among them is the loss of skeletal muscle mass that a significant percentage of patients with COPD will show during the course of their disease. This limits considerably their exercise capacity, jeopardizes their health status, and has a negative impact on their prognosis. Importantly, such prognostic value is independent of the degree of airflow obstruction and potentially reversible with appropriate therapy. This chapter summarizes available evidence supporting the concept that COPD is more than a lung disease (the systemic effects of COPD), and speculates on potential cellular mechanisms as future therapeutic targets.
传统上，慢性阻塞性肺疾病（COPD）被认为是一种肺部疾病，其特征是由于慢性支气管炎和/或肺气肿导致不可逆的气流受限。后者主要被认为是对吸烟过度炎症反应的结果。最近，多项研究表明，这种肺部炎症也可能在体循环中被检测到，并且这种全身炎症可能具有重要的临床后果。其中最突出的是相当比例的COPD患者在病程中会出现骨骼肌质量的丧失。这极大地限制了他们的运动能力，危及他们的健康状况，并对他们的预后产生负面影响。重要的是，这种预后价值独立于气流阻塞程度，并且通过适当的治疗可能是可逆的。本章总结了支持COPD不仅仅是一种肺部疾病（COPD的全身影响）这一概念的现有证据，并推测了作为未来治疗靶点的潜在细胞机制。
