All roads lead to COPD… or not?

Abstract

Our understanding of the pathogenesis of Chronic Obstructive Pulmonary Disease (COPD) has changed very significantly over the past few years [1-4]. Since the seminal description by Fletcher and Peto back in 1976, COPD was traditionally understood as a self-inflicted disease by tobacco smoking occurring in old, “susceptible” males and characterized by an accelerated decline of lung function with age. By contrast, according to the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations, COPD is now understood as a “heterogeneous condition that results from gene (G) - environment (E) interactions occurring over the lifetime (T) of the individual (GETomics) that can damage the lungs and/or alter their normal development/ageing process”.