Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality worldwide. Traditionally viewed as a disease caused by exposure to harmful particles and gases (primarily tobacco smoke) and characterized by incompletely reversible bronchial obstruction, COPD is currently understood as a complex, heterogeneous, and systemic pathology. This review article highlights current understanding of COPD pathogenesis, focusing on key mechanisms: chronic inflammation, oxidative stress, protease and antiprotease imbalance , and autoimmune processes. Particular attention is paid to the concept of COPD pathomorphosis —the historical change in the clinical and morphological manifestations of the disease under the influence of environmental factors, new treatments, and changing pathomorphological profiles of patients. The shift from the classical dichotomy of chronic bronchitis/emphysema to an understanding of multiple phenotypes and endotypes of the disease is emphasized, opening the way to personalized therapy.

COPD, pathogenesis, pathomorphosis , systemic inflammation, oxidative stress, phenotypes, airway remodeling .

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