The estimated direct cost of COPD is $29.5 billion and the indirect cost $20.4 billion in the United States (GOLD, 2013). Although COPD has been traditionally considered as a disease primarily affecting the lungs, its systemic effects have been increasingly recognized with diverse manifestations involving the other body systems (Eisner, Blanc, & Yelin, 2008). It also has been traditionally
considered as a disease of the elderly, but can affect the working age population.