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"Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality worldwide. By 2020, COPD is expected to be the fifth leading cause of disability and the third leading cause of death. COPD is associated with significant co-morbid illnesses including cardiovascular disease, pulmonary vascular disease, osteoporosis, depression and thoracic malignancies. In addition, COPD patients often have systemic manifestations of their disease, including peripheral muscle dysfunction, decreased activity levels and nutritional abnormalities, all of which contribute to poor functional status, decreased quality of life and increased health care utilization. Lack of recognition and understanding of the complex interactions of these common co-morbid conditions and systemic effects often contributes to sub-optimal care for patients with COPD."