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Although the role of socioeconomic status in COPD has been poorly investigated when studying the determinants of respiratory health in ‘real life’, lower education levels and economic status have been presumed to lead to a higher probability of suffering from this disease [3–5] . Actually, these two conditions tend to work as main determinants of patients’ future because they usually lead to poorer housing and nutritional intake, a higher incidence of respiratory infections (particularly in childhood), a higher prevalence of smoking, a higher probability of accepting disadvantaged jobs, etc. [6] . In other words, the lower the start level the steeper the way to the finish line. In this issue of Respiration, Miravitlles et al. [7] specifically investigated and focused on this peculiar aspect and clearly assessed how both the socioeconomic and the educational status of COPD subjects can affect (or can have affected) primarily their quality of life and other related outcomes in real life (i.e. an early diagnosis, early treatment, awareness of the disease, etc.). This paper also showed that the socioeconomic status (e.g. the individual’s educational level and income) represents an independent factor which proves able to substantially impair the health status of COPD patients also in a public heath system oriented toward the welfare model. The current understanding of chronic obstructive pulmonary disease (COPD) is still incomplete, and several factors contribute to its overall impact in both industrialized and developing countries. The epidemiology of COPD has been investigated extensively over the last decades and the role of many causative and predisposing factors have been focused on, though most attention has usually been concentrated on the specific function of some behavioral (i.e. tobacco smoke), clinical (i.e. respiratory signs, lung function), and biological (i.e. age, gender, infections, genetics) determinants of the disease [1] . COPD is a complex disease characterized by numerous pulmonary and extra-pulmonary components which contribute significantly to its heterogeneity in terms of clinical manifestations, physiological pictures, radiological imaging, response to therapeutic treatments, morbidity, and survival. Moreover, the complexity of the disease cannot be represented exhaustively by a single parameter, and integrated indices considering different factors simultaneously have been progressively proposed and suggested as being much more sensitive, though they still mainly stem from clinical and physiological peculiarities [2] . Published online: August 18, 2011

The Socioeconomic Status of Subjects: A Prominent Feature Contributing to the Phenotypical Approach to COPD