Abstract: Existing studies on chronic obstructive pulmonary disease (COPD) have mostly focused on airway lesions, with insufficient attention paid to the critical role of alveolar structural damage. Alveolar loss-type COPD, characterized primarily by emphysema, is the core structural basis for lung function decline and worsening clinical outcomes. This article systematically reviews the pathological network mediating alveolar loss through multiple mechanisms, including protease-antiprotease imbalance, persistent activation of oxidative stress, chronic inflammatory responses and differences in inflammatory endotypes, autoimmune abnormalities, and impaired repair function of alveolar epithelial and mesenchymal cells. It focuses on analyzing the synergistic effects of targeted Western medical therapies and traditional Chinese medicine treatment based on syndrome differentiation in regulating the inflammatory microenvironment and improving repair capacity, explores the value of non-pharmacological interventions in comprehensive management, and clarifies the multiple mechanism-mediated regulatory network of alveolar loss and the potential of integrated traditional Chinese and Western medicine interventions. From an integrated perspective of structural damage, inflammatory milieu, and repair imbalance, this article provides a theoretical basis and practical reference for precision classification, diagnosis, and treatment of alveolar loss-type COPD and combined Chinese and Western medicine interventions.