Reframing disease elimination: an update from the Lancet Commission on chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality worldwide, with increasing global burden driven by population growth and ageing, persistent harmful exposures, and substantial health inequities. The Lancet Commission on COPD articulated an ambitious vision for disease elimination with prevention, early detection, and intervention. This Review revisits that vision, assesses progress since 2022, and calls for a broader commitment to lifelong lung health as an update of the Commission. Across seven sections, this Review advances a unified framework integrating the biology of lung development and ageing, precision medicine, patient-centred outcomes, and regulatory reform. COPD is not a single, uniform disease; rather, a biologically complex condition shaped by genetic, developmental, environmental, infectious, and behavioural factors across the entire life course. Effective prevention and care should therefore move beyond the detection and treatment of late physiological impairment toward earlier disease recognition, biological stratification, and interventions to preserve lung health, reduce symptoms, and prevent morbidity and premature mortality. The Review charts a path from reactive, late-stage management toward proactive, equitable, precision-based prevention and care. The central premise is unequivocal: the global burden of COPD can be substantially reduced. Success should be measured not only by gains in lung function and survival but also by improvements in daily functioning, quality of life, and wellbeing. In this expanded vision, COPD is no longer viewed solely as a chronic disease to be managed but as a preventable and modifiable condition within a broader commitment to lifelong lung health.