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Furthermore, a combinatorial approach targeting both NLRP3 activation and oxidative stress has been proposed as a promising therapeutic strategy, with the potential to restore small airway function, mitigate structural injury, and ultimately prevent disease progression ( Remodeling phase Proliferation of smooth muscle cellsFibrosisVascular Pruning Airway smooth muscle (ASM) in COPD small airway pathology commonly exhibits cellular hyperplasia and hypertrophy, leading to airway wall thickening, increased airway contractility, and directly contributing to small airway stenosis and airflow limitation (60), and may be exacerbated by fibrosis compression (61), its independent impact on the disease course and clinical outcome highlights its core importance in the pathogenesis