Airflow limitation with intractable progressive mechanisms is the main disease feature of
chronic obstructive pulmonary disease (
COPD). The pathological process of airflow limitation in
COPD involves necroptosis, a form of programmed necrotic cell death with pro-inflammatory properties. In this paper, the correlations of small-airway disease and
emphysema with airflow limitation in
COPD were firstly reviewed; then, based on this, the effects of necroptosis on small-airway disease and
emphysema were analysed, and the possible mechanisms of necroptosis causing airflow limitation in
COPD were explored. The results showed that airflow limitation is caused by a combination of small-airway disease and
emphysema. In addition, toxic
particulate matter stimulates epithelial cells to trigger necroptosis, and necroptosis promotes the expulsion of cell contents, the abnormal
hyperplasia of pro-inflammatory mediators and the insufficient clearance of dead cells by macrophages; these processes, coupled with the interaction of necroptosis and oxidative stress, collectively result in small-airway disease and
emphysema in
COPD.