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Although airflow obstruction is the most obvious and most studied manifestation of chronic obstructive pulmonary disease (COPD), it should not be overlooked that COPD, particularly in its later stages, is associated with many extrapulmonary features that contribute to the morbidity, reduced quality of life, and, possibly, mortality of this disease. We review here the literature on skeletal muscle dysfunction, osteoporosis, and weight loss in COPD, with particular attention to possible approaches to their management. Patients with COPD may also have other extrapulmonary effects such as hormonal abnormalities that could probably be corrected, but less is known about them. COPD, therefore, should be regarded as a systemic disorder. Its systemic manifestations should not be overlooked in the overall care of the patient, because there are important ways in which they can be addressed.

Since the beginning of the twentieth century, radiation has been employed as a tool to cure or palliate malignancy. Unfortunately, soon after its discovery, the harmful effects of radiation were recognized as well. As our understanding of the physiologic responses to radiation increases, we can refine the routes of delivery and dosages of radiation administered. The use of three-dimensional treatment planning and the manipulation of the biochemical response with drugs and synthesized cytokines offers promise in curtailing the undesirable effects of irradiation. Side effects will be minimized and benefits maximized with further technologic developments that will more accurately control the delivery of and response to radiation.

Chronic obstructive pulmonary disease is the fourth leading cause of death in the United States, affecting approximately 10% of all adults. Several articles published during the past year contributed significantly to our understanding of the complicated management of this disease. New information concerning bronchodilators, antibiotic therapy, mechanical ventilation, pulmonary rehabilitation, nutrition, and lung transplantation will help physicians further refine the care delivered to these patients.