The place of comorbidities in 'COPD control panel'

Thorax

We read with interest about the new chronic obstructive pulmonary disease (COPD) care framework proposed by Agustí and MacNee.1 The ‘control panel’ idea is very interesting and useful because it allows keeping in mind all we need for making optimal treatment decisions. But this aircraft cockpit metaphor reminded us that current evidence-based guidelines resemble the flight simulator rather than the real plane. In our everyday practice we base our decisions on the ‘dummy’ evidence derived from purified non-representative cohorts of COPD patients.2 Examples are Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index and COPD Assessment Test (CAT) that were developed in the studies without significantly comorbid patients. As well as the majority of inhaled treatments that were never specifically evaluated in multimorbid patients. But it is absolutely obvious that in real-life COPD patients, comorbidities are definitely the second prevalent sign after non-reversible...