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These immune cells exacerbate tissue injury through cytotoxicity and the release of inflammatory mediators, and are closely associated with the development of emphysema ( FIGURE 1 Cellular senescence, the senescence-associated secretory phenotype (SASP), miR-34a, and sirtuins (SIRT1/6) Chronic inflammation and oxidative stress induce epithelial cells, fibroblasts, and endothelial cells into a senescent phenotype through the ATM/ATR-p53/p21 pathway ( In summary, the inflammation-senescence axis drives the progression of small airway disease toward COPD, forming a vicious cycle