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COPD is a clinical syndrome representing a spectrum of lung pathologies associated with systemic comorbidities and exacerbations, which contribute substantial morbidity and mortality. The ‘umbrella’ nature of the syndrome has resulted in the detailed investigation and description of multiple disease phenotypes relating to the heterogeneity of lung pathophysiology but also to other clinical features such as symptom burden, exacerbations, comorbidities, nutritional status and respiratory failure.1–5 Phenotype-specific therapies already exist, for example, lung volume reduction therapies, nutritional support and home non-invasive ventilation. Moreover, this may extend to other features such as increased cardiovascular risk and inflammometry-directed exacerbation management.6 ,7
These advances provide an opportunity to make a significant change in the care of patients with COPD both by personalising the management of patient symptoms and future health risk (as embodied in the updated Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging schema8) and by the proactive identification and treatment of systemic comorbidities that are known to impact on health outcomes. For these scientific developments to translate to patient care, a more detailed, systematic framework for clinical assessment is needed in routine clinical practice. Such an approach is also required to stratify care across the range of disease severity/complexity so that care can be individualised and services organised accordingly. In keeping with this, the UK National Health Service (NHS) National Outcomes Strategy for COPD recommends that the assessment of disease severity should be based on a ‘comprehensive assessment’ of clinical characteristics and that services should be integrated to ensure specialist care focuses on more ‘complex or unstable’ disease.9 Currently, however, in the UK and many other healthcare systems, proactive identification and management of complex medical, psychological and social care needs in COPD occurs infrequently and is poorly coordinated.10 By contrast, a structured approach to managing …
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