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VOL. 8, ISSUE 3 (2026)
The COPD lung: Pathobiology, diagnostic advances, systemic comorbidity, and evolving therapeutic strategies — A narrative review
Authors
Vica Hilda Amelia, Muhammad Hamza Mubarak, Ika Fidianingsih
Abstract
Chronic obstructive pulmonary disease (COPD)
remains one of the leading causes of morbidity and mortality worldwide, with
its defining lesion, the COPD lung, shaped by a convergence of chronic
inhalational injury, dysregulated repair, and persistent inflammation. This
narrative review synthesizes contemporary evidence on the structural and
cellular pathology of the COPD lung, including emphysematous alveolar
destruction, small-airway fibrosis, and vascular remodeling, alongside the
innate and adaptive immune circuits, oxidative stress pathways, and cellular
senescence programs that sustain disease progression. Genetic susceptibility,
notably alpha-1 antitrypsin deficiency, and environmental exposures such as tobacco
and household biomass smoke are discussed as complementary drivers of
phenotypic heterogeneity. The review further examines diagnostic advances,
including quantitative computed tomography phenotyping and circulating and
airway biomarkers, the growing recognition of COPD as a systemic disease with
cardiovascular, musculoskeletal, and metabolic comorbidities, and the expanding
pharmacological armamentarium spanning bronchodilators, inhaled
corticosteroids, triple combination therapy, and the newly approved biologic
agents dupilumab and mepolizumab for eosinophilic COPD. Non-pharmacological
interventions, particularly pulmonary rehabilitation, are considered within a
treatable-traits framework. Collectively, the evidence points toward a
precision-medicine paradigm in which endotype-directed therapy, earlier
detection through imaging and biomarker panels, and integrated management of
comorbidities may finally begin to alter the historically relentless trajectory
of the COPD lung.
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Pages:32-42
How to cite this article:
Vica Hilda Amelia, Muhammad Hamza Mubarak, Ika Fidianingsih "The COPD lung: Pathobiology, diagnostic advances, systemic comorbidity, and evolving therapeutic strategies — A narrative review". International Journal of Medical Science and Clinical Research, Vol 8, Issue 3, 2026, Pages 32-42
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