**1. Introduction**

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease worldwide, characterized by persistent airflow limitation and

associated respiratory symptoms. Its pathological features are mainly chronic inflammatory changes in airway, lung parenchyma, and pulmonary vessels, which are usually associated with exposure to harmful particles and gases. Many factors, such as genetic susceptibility, abnormal inflammatory response, and abnormal lung development, are involved in the pathogenesis. In 2020, there were about 550 million (about 7.4%) COPD patients in the world, with the highest proportion of patients with COPD in Oceania (about 10.9%) and the lowest in Africa (about 5.4%) [1]. It mainly affects the population over 40 years old. Men and women are at equal risk. In 1990, COPD caused appropriate 2.4 million deaths. Until 2019, the global deaths rose to 3.23 million. About 80% of the deaths occurred in low- and middle-income countries, on the one hand, due to the high prevalence of smoking. On the other hand, it is difficult for the public and medical workers to obtain information on diagnosis and treatment management in terms of the low coverage of COPD diagnosis (69.8% in low- and middle-income countries, 98.1% in high-income countries) [2]. With the increasing smoking rate in developing countries and the aging population in high-income countries, the latest data of the World Health Organization show that the prevalence of COPD will continue to rise in the next 40 years with more than 5.4 million deaths from COPD and its related diseases annually by 2060. COPD has become an important public health problem in the world because of its high incidence, high mortality, and social and economic burden. Advances in pulmonary imaging have enabled more detailed understandings of airway and parenchymal abnormalities, and new endoscopic interventions are playing an increasingly important role in the management of advanced emphysema. At present, there is still no etiology-specific treatment for emphysema other than the addition of alpha 1 antitrypsin in patients with emphysema associated with alpha 1 antitrypsin deficiency. Further prospective studies could help clarify the role of inhaled corticosteroids in combination with dual bronchodilator therapy in the prevention of exacerbations. Compared with asthma, there is little hope for developing COPD-specific biotherapies. However, we still cannot give up investigation of COPD pathogenesis and developing scientific prevention and management methods. Therefore, this chapter focuses on the pathogenesis of COPD and the latest research advances in treatment and management of COPD.
