Chronic obstructive pulmonary disease (COPD) is a disorder characterized by reduced maximum expiratory flow and slow forced emptying of the lungs due to airway and emphysema diseases. While traditionally focused on pulmonary pathology, recent studies have identified significant systemic effects of COPD, including systemic inflammation, nutritional abnormalities, skeletal muscle dysfunction, and other potential systemic effects. These systemic effects are clinically relevant and influence the classification and management of the disease. Systemic inflammation in COPD is marked by increased levels of proinflammatory cytokines, oxidative stress, and activated inflammatory cells. These factors contribute to systemic effects such as skeletal muscle dysfunction (SMD), which is a major contributor to exercise limitation in COPD patients. SMD is characterized by a net loss of muscle mass and dysfunction of remaining muscle, influenced by intrinsic muscle alterations and external factors like hypoxia and acidosis. Mechanisms include mitochondrial abnormalities, increased apoptosis, and oxidative stress. Nutritional abnormalities, including weight loss, are also significant in COPD. Weight loss is a poor prognostic factor and can be reversed with appropriate therapy. It is associated with increased metabolic rate and systemic inflammation, and nutritional support combined with exercise is crucial for improving quality of life and prognosis. Other systemic effects include cardiovascular issues, nervous system abnormalities, and osteoskeletal effects. These are influenced by systemic inflammation, oxidative stress, and other factors. The systemic nature of COPD suggests that it is not merely a lung disease but a complex condition affecting multiple systems. Understanding these systemic effects is essential for developing comprehensive treatment strategies that address both pulmonary and extrapulmonary manifestations of COPD.Chronic obstructive pulmonary disease (COPD) is a disorder characterized by reduced maximum expiratory flow and slow forced emptying of the lungs due to airway and emphysema diseases. While traditionally focused on pulmonary pathology, recent studies have identified significant systemic effects of COPD, including systemic inflammation, nutritional abnormalities, skeletal muscle dysfunction, and other potential systemic effects. These systemic effects are clinically relevant and influence the classification and management of the disease. Systemic inflammation in COPD is marked by increased levels of proinflammatory cytokines, oxidative stress, and activated inflammatory cells. These factors contribute to systemic effects such as skeletal muscle dysfunction (SMD), which is a major contributor to exercise limitation in COPD patients. SMD is characterized by a net loss of muscle mass and dysfunction of remaining muscle, influenced by intrinsic muscle alterations and external factors like hypoxia and acidosis. Mechanisms include mitochondrial abnormalities, increased apoptosis, and oxidative stress. Nutritional abnormalities, including weight loss, are also significant in COPD. Weight loss is a poor prognostic factor and can be reversed with appropriate therapy. It is associated with increased metabolic rate and systemic inflammation, and nutritional support combined with exercise is crucial for improving quality of life and prognosis. Other systemic effects include cardiovascular issues, nervous system abnormalities, and osteoskeletal effects. These are influenced by systemic inflammation, oxidative stress, and other factors. The systemic nature of COPD suggests that it is not merely a lung disease but a complex condition affecting multiple systems. Understanding these systemic effects is essential for developing comprehensive treatment strategies that address both pulmonary and extrapulmonary manifestations of COPD.