Towards a multi-dimensional approach to COPD

Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. Clinical features of the disease include exertional dyspnea and chronic cough, while persistent airflow obstruction detected at spirometry is the defining element of the disease. Notably, subjects with smoke exposure and symptoms, but normal FEV1/FVC ratio (previously classified as "stage 0" by the GOLD classification), are not considered affected and do not require treatment according to guidelines. The recent GeneCOPD study suggested that a proportion of this population might present significant radiological features of respiratory disease. This commentary article focuses on the possible future role of chest imaging, including ultrasound of the respiratory muscles, integrated with additional functional tests, such as body plethysmography and diffusing capacity for carbon monoxide of the lungs (DLCO), in a multidimensional assessment of COPD.