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Although the underlying mechanisms responsible for COPD remain poorly understood, over the past several decades, clinical phenotypes and endotypes have been suggested. These include frequent exacerbator and eosinophilic groups that guide tailored therapies for patients with that clinical expression. In the developed world, smoking is the main known cause of COPD, responsible for \u223c80% of cases. Active smokers have more severe disease, with more rapid lung function decline and impaired quality of life, than former smokers. Unfortunately, smoking is still highly prevalent. Rates range between 3% and 37% globally, with factors including sex, age, race, education, and geography influencing the rate of addiction. Importantly, several studies have shown that smoking detrimentally affects treatment efficacy of COPD medications; this is particularly true of inhaled corticosteroids and macrolides. In this review, we discuss the effects of smoking on the pathophysiology of COPD and the clinical impact of smoke exposure in patients with COPD.<\/jats:p>","DOI":"10.1164\/rccm.202407-1379ci","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T16:45:55Z","timestamp":1739378755000},"page":"729-736","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":30,"title":["Current Smoker: A Clinical Chronic Obstructive Pulmonary Disease Phenotype Affecting Disease Progression and Response to Therapy"],"prefix":"10.1093","volume":"211","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7266-8371","authenticated-orcid":false,"given":"Bartolome R.","family":"Celli","sequence":"first","affiliation":[{"name":"Pulmonary and Critical Care Division, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie A.","family":"Christenson","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus F.","family":"Rabe","sequence":"additional","affiliation":[{"name":"LungenClinic Grosshansdorf, Grosshansdorf, Germany"},{"name":"Christian Albrechts University of Kiel, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MeiLan K.","family":"Han","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"van den Berge","sequence":"additional","affiliation":[{"name":"Groningen Research Institute for Asthma and COPD and"},{"name":"Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard J.","family":"Criner","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Soler","sequence":"additional","affiliation":[{"name":"Regeneron Pharmaceuticals Inc., Tarrytown, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Djandji","sequence":"additional","affiliation":[{"name":"Sanofi, Cambridge, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Radwan","sequence":"additional","affiliation":[{"name":"Regeneron Pharmaceuticals Inc., Tarrytown, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Rowe","sequence":"additional","affiliation":[{"name":"Sanofi, Bridgewater, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yamo","family":"Deniz","sequence":"additional","affiliation":[{"name":"Regeneron Pharmaceuticals Inc., Tarrytown, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juby A.","family":"Jacob-Nara","sequence":"additional","affiliation":[{"name":"Sanofi, Bridgewater, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,1]]},"reference":[{"key":"2026031105315729200_bib1","article-title":"Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease","author":"Global Initiative for Chronic Obstructive Lung Disease","year":"2022"},{"key":"2026031105315729200_bib2","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1056\/NEJMra1900500","article-title":"Update on clinical aspects of chronic obstructive pulmonary disease","volume":"381","author":"Celli","year":"2019","journal-title":"N Engl J Med"},{"key":"2026031105315729200_bib3","first-page":"S77","article-title":"Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease","volume":"152","author":"American Thoracic Society","year":"1995","journal-title":"Am J Respir Crit Care Med"},{"key":"2026031105315729200_bib4","doi-asserted-by":"crossref","first-page":"53","DOI":"10.15585\/mmwr.mm6702a1","article-title":"Current cigarette smoking among adults\u2014United States, 2016","volume":"67","author":"Jamal","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026031105315729200_bib5","author":"World Health Organization","year":"2021","edition":"4th ed."},{"key":"2026031105315729200_bib6","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: a systematic analysis from the Global Burden of Disease Study 2019","volume":"397","author":"GBD 2019 Tobacco Collaborators","year":"2021","journal-title":"Lancet"},{"key":"2026031105315729200_bib7","article-title":"Current cigarette smoking among adults in the United States","author":"Centers for Disease Control and Prevention","year":"2020"},{"key":"2026031105315729200_bib8","doi-asserted-by":"crossref","first-page":"145","DOI":"10.2188\/jea.JE20190344","article-title":"Who smokes in Europe? 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