New perspectives in phenotyping and endotyping of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition and a leading cause of morbidity and mortality worldwide. COPD represents a constellation of distinct etiotypes, clinical phenotypes, and pathogenetic endotypes, which necessitates a shift toward personalized approaches in diagnosis and treatment. Objective. To summarize recent advances in the phenotyping and endotyping of COPD. Material and methods. A literature search was conducted in the electronic databases PubMed, Cochrane Library, eLIBRARY.RU, and CyberLeninka for the period 2001—2026. Original studies by various research groups were selected for analysis. Results. COPD is a heterogeneous disease encompassing diverse etiotypes (e.g., air pollution—related, genetic, etc.), pathophysiological endotypes (neutrophilic, eosinophilic, autoimmune, vascular), and clinical phenotypes (PRISm, pre-COPD, COPD—asthma overlap). Identification of the eosinophilic endotype has provided a rationale for the use of anti-IgE and anti-IL-5/IL-4Rα therapies in appropriate patient subgroups. The concepts of pre-COPD and PRISm define high-risk groups, enabling early diagnosis and prevention of disease progression. In light of newly identified etiotypes, endotypes, and phenotypes of COPD, it is essential to implement the principles of personalized medicine by targeting key pathogenic mechanisms in individual patients. Conclusions. The current understanding of COPD as a composite of overlapping etiotypes, endotypes, and phenotypes provides a foundation for personalized therapy. The introduction of phenotypic stratification algorithms into clinical practice is a prerequisite for optimizing therapy and improving disease prognosis. Further research should focus on validating diagnostic criteria, deepening insights into pathophysiology, and developing novel targeted therapies for distinct COPD subtypes.