TY - JOUR T1 - Symptomatic, frail, elderly patients: the urgent need for comprehensive assessment and management JF - European Respiratory Journal JO - Eur Respir J SP - 1397 LP - 1400 DO - 10.1183/09031936.00150814 VL - 44 IS - 6 AU - Enrico Clini AU - Bianca Beghe AU - Leonardo M. Fabbri Y1 - 2014/12/01 UR - http://erj.ersjournals.com/content/44/6/1397.abstract N2 - The working hypotheses for screening and early diagnosis of chronic obstructive pulmonary disease (COPD) have been that: 1) long-term exposure to cigarette smoke or pollutants damages the airways and/or the lungs, and causes airflow obstruction [1, 2]; 2) airflow obstruction occurs primarily in the small airways, is asymptomatic in the early stages of the disease and is progressive in the majority of COPD patients [1–4]; and 3) forced expiratory volume in 1 s (FEV1) and its ratio with forced vital capacity are necessary in establishing the diagnosis of COPD, and in assessing the excessive decline in lung function [1], but are of little use, if any, in making the early, pre-symptomatic diagnosis of COPD [5].These working hypotheses have been helpful in stimulating research in the field of structure–function relationships in the lung, and particularly in defining the role of airway and lung inflammation in the development of central and peripheral airway remodelling and emphysema [2, 3, 6]. Research focused on the respiratory system has also brought about the development of physiological and imaging methods to assess peripheral airways and lung parenchyma [7–9], and has furthered understanding of the natural history of COPD, particularly the progressive decline in lung function and its modulation by pharmacological intervention [10]. Thanks to the results of these studies, we now know much more about COPD, about the potential and limitations of screening [11] and early diagnosis based on spirometry, and about interventions in early asymptomatic and newly discovered COPD.Screening subjects at risk, such as smokers, workers and populations exposed to environmental pollution, with serial measurements of FEV1 has been shown to identify COPD at an early stage, with … ER -