abstract
- Non-smoking COPD is common in LMICs, especially in women. Biomass fuel and air pollution are major risk factors with distinct pathophysiology. The 'eosinophilic' endotype in COPD is biologically distinct from asthma. PRISm, FEV1/FVC Z-scores, and quantitative CT improve early COPD detection. Dupilumab (anti-IL-4/IL-13) improved exacerbations and lung function in COPD with blood eosinophils ≥ 300 cells/μL. Mechanisms are currently being investigated. Smoking cessation remains pivotal. Nicotine metabolite ratio (NMR) can guide pharmacotherapy. Cytisine and varenicline are effective; e-cigarettes pose safety concerns. Mood disorders and dysfunctional breathing are common in COPD. Addressing these can reduce symptom burden and improve quality of life. Comorbidity management, particularly of cardiovascular risk, obesity, and sleep-disordered breathing, is integral to holistic COPD care.