Pathogenesis, Diagnostic Advances, and Therapeutic Management of Chronic Obstructive Pulmonary Disease: A Narrative Review.

Chronic obstructive pulmonary disease (COPD) is a leading global cause of morbidity and mortality, now recognized as a complex, heterogeneous disorder driven by environmental exposures, genetic susceptibility, immune dysregulation, and accelerated lung aging rather than solely by airflow limitation. This shift in understanding has fundamentally altered perspectives on its development and treatment. This narrative review synthesizes recent advances from 141 studies identified through a structured literature search of PubMed and Web of Science. It explores the molecular and cellular mechanisms of COPD pathogenesis and the resulting structural and functional lung changes. The review highlights innovations in diagnostics, including advanced imaging, physiological assessments, and biomarkers that enable more precise patient classification beyond spirometry. Progress in pharmacotherapy includes personalized inhaled therapies and targeted anti-inflammatory agents, while non-pharmacological approaches such as pulmonary rehabilitation and digital health technologies are increasingly integral to comprehensive management. Despite these advances, challenges persist, including inconsistent early detection, a lack of disease-modifying treatments, and significant variability in disease course and treatment response. This review provides a cohesive overview of current knowledge, identifies ongoing research needs, and outlines priorities for advancing personalized, mechanism-based care for COPD patients.