features of COPD, e.g. sarcopenia or depression, and variability in the threshold for dyspnoea play a major causal role. Accordingly, only a comprehensive view of COPD allows us to recognise both determinants of health status and related needs of care. The primary aim of the current issue of the European Respiratory Monograph is to make respiratory physicians, general practitioners and any other physicians caring for elderly respiratory patients fully aware of how their role goes beyond the care of the respiratory problem. This requires specific competance and a problem-solving approach based on a truly multidisciplinary process of care. Unfortunately, multidisciplinary and comprehensive home and hospital care programmes for respiratory patients are distinctly rare or limited to selected populations, which makes their conclusions barely generalisable [5]. However, some positive evidence can be confidently drawn from mono-dimensional experiences. For example, patients’ education can decrease COPD-related hospitalisations, while regular physical activity is associated with reduced hospitalisation and mortality in COPD patients [6, 7], and rehabilitation can improve personal independence even in severe COPD [8, 9]. It is likely, yet unproved, that combining individually effective measures will favourably affect more outcomes of care. Pursuing such an objective will make respiratory physicians and general practitioners able to propose cost-effective solutions for assisting elderly respiratory patients. Otherwise, it will be very difficult to help our patients beyond the realm and the boundaries of our personal practice, particularly in times of resource shortage. In conclusion, this issue of the European Respiratory Monograph will have reached its objective if the reader makes his/her approach to the elderly respiratory patient truly comprehensive and his/her working model truly cooperative and then multidisciplinary. Table 1. – Examples of topics that are not systematically covered by the usual didactic in respiratory medicine and are commonly underrepresented in the cultural patrimony of both respiratory physicians and general practitioners Neglected topic Effect of poor awareness Effects of multidisciplinary care on the health status of geriatric patients Research activity: trials, most of which are funded by pharmaceutical companies, are designed to test new drugs and not new (to respiratory medicine) strategies of care. Clinical practice: important interventions lie outside the realm of current practice. Atypical presentation of respiratory diseases Nonrespiratory, e.g. neurological or psychiatric, symptoms may not help detect an exacerbated or acute respiratory disease. Age-related technical problems with respiratory function tests Frail patients are commonly excluded from clinical trials. Proposed guidelines might not apply to these patients. Availability of ‘‘low cost’’ spirometric measures that are alternative to FEV1 and FVC Elderly patients do not benefit from measures that have well-proved classificatory, discriminative and prognostic implications. Poor quality of spirometric reference standards for the elderly Spirometric measures, when available, are interpreted without the due caution Spectrum of risk factors for and mechan- isms of aspiration pneumonia Patient at risk is not recognised in time and preventive measures are not adopted. Comorbidity as a factor complicating and confounding the clinical picture in COPD The interpretation of complex clinical pictures is oversimplified. Palliative and end-of-life care of the respiratory patient Poor quality of the care provided to very sick patients FEV1: forced expiratory volume in one second FVC: forced vital capacity COPD: chronic obstructive pulmonary disease. x