Chronic Obstructive Pulmonary Disease (COPD) remains a leading cause of morbidity and mortality worldwide. This review explores the evolving epidemiology of COPD with a focus on recent trends, disease trajectories, and emerging etiotypes. The key aspects discussed include the impact of smoking, early life events, and genetic predispositions, alongside non-traditional risk factors such as indoor and outdoor air pollution and infections. Additionally, this article highlights the contribution of global initiatives to control COPD risk factors and the potential for personalized approaches in prevention and treatment. By addressing these diverse dimensions, we aim to provide a comprehensive understanding of the current knowledge of the complexity and heterogeneity of COPD.