This Lancet Commission presents a new vision for COPD by framing it as a preventable and heterogeneous disease shaped not only by tobacco exposure, but also by early-life factors, infections, poverty, and environmental exposures. It calls for broader and earlier diagnosis beyond spirometry alone, more precise classification of COPD according to underlying risk factors, stronger prevention across the life course, better management of exacerbations, improved access to effective treatments, and greater investment in research and health systems. The paper is highly relevant for countries facing a growing burden of chronic respiratory disease because it connects clinical care, public health, clean air, tobacco control, and health system reform. It is a useful resource for policy dialogue, advocacy, and programme planning on integrated COPD services.