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Lastly, 3 (16.6%) patients developed hypocarnitinemia at the last timepoint follow-up (2+ years)

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The process of selecting papers, data collection as well as the quality assessment was performed independently by two authors (A.S., G.R.), and all disagreements were resolved by the discussion with the third author (R.O)

Since COPD is a complex and multifaceted disease, the concepts of phenotypes (i.e., subgroups with prognostic impact) and endotypes (i.e., conditions defined by specific pathophysiological and molecular mechanisms) have begun to be applied to achieve the goal of personalized medicine and a more efficient diagnostic and therapeutic approach