Characteristic pathologic changes in chronic obstructive pulmonary disease (COPD) include an increased fractional volume of bronchiolar epithelial cells, fibrous thickening of the airway wall, and luminal inflammatory mucus exudates, which are positively correlated with airflow limitation and disease severity. The mechanisms driving general epithelial expansion, mucous secretory cell hyperplasia, and mucus accumulation must relate to the effects of initial toxic exposures on patterns of epithelial stem and progenitor cell proliferation and differentiation, eventually resulting in a self-perpetuating, and difficult to reverse, cycle of injury and repair. In this review, current concepts in stem cell biology and progenitor-progeny relationships related to COPD are discussed, focusing on the factors, pathways, and mechanisms leading to mucous secretory cell hyperplasia and mucus accumulation in the airways. A better understanding of alterations in airway epithelial phenotype in COPD will provide a logical basis for novel therapeutic approaches.Keywords: epithelium; hyperplasia; metaplasia; mucus hypersecretion; stem cellsThe human and societal toll of chronic obstructive pulmonary disease (COPD) is considerable, and there is a clear need for better prevention and early detection/intervention, including more specific and effective therapies for all stages of the disease. COPD is characterized by, and defined as, sustained and largely irreversible airflow limitation on forced exhalation, associated with known risk factors and excluding other specific causes (1, 2). The key pathologic changes underlying the physiologic hallmarks are loss of lung elasticity and small airway tethers due to emphysema, thickening of the small airway wall to reduce caliber, and luminal obstruction with inflammatory mucoid secretions (3-5). The airway epithelium is a primary interface with the outside world and is a target of the toxic particles and gases from tobacco smoke and other environmental agents that are the main cause of COPD. As indicated by changes in gene expression, airway epithelial cells respond dynamically to the inciting stimuli (6) and are the focus of viral (7) and bacterial (8-10) infections that exacerbate COPD and accelerate deterioration of lung function. The characteristic pathologic changes in the airway epithelium (Figures 1 and 2) are integral to the initiation and progression of COPD. Generalized epithelial hyperplasia, mucous secretory cell hyperplasia, squamous metaplasia, and mucus accumulation must result from disruptions in normal cell and tissue dynamics caused by both the initial stimuli and the spiral of infectious complications. Locations of stem cells, patterns of cell migration/differentiation, and the regulatory mecha-