Endothelial dysfunction in chronic obstructive pulmonary disease: an update on mechanisms, assessment tools and treatment strategies

Chronic obstructive pulmonary disease (COPD) is a complex condition marked by chronic respiratory symptoms, such as cough and dyspnoea, and persistent irreversible airway obstruction, punctuated by acute episodes of exacerbations. COPD is associated with a significant mortality risk and several comorbidities, including cardiovascular diseases. The link between COPD, acute exacerbations and cardiovascular diseases has been recently acknowledged under the unifying concept of cardiopulmonary risk. In this context, endothelial dysfunction (ED) has been identified as a key contributor to the systemic manifestations of COPD and an early event in atherogenesis, thus potentially linking respiratory diseases and cardiovascular risk. Assessing endothelial dysfunction could therefore provide valuable prognostic insights into COPD, while targeting it may emerge as a promising therapeutic approach. Nonetheless, several aspects such as clinical assessment options and potential treatment strategies are still under debate, despite an intense research activity in recent years and promising results coming from the field of pulmonary rehabilitation medicine, which seems to be highly beneficial for the improvement of ED in COPD patients. On these premises, this mini review aims to provide an updated overview of the pathophysiology of ED in the context of COPD, with a focus on its assessment and its potential as an attractive therapeutic target.