• COPD-induced neurocognitive disorders (COPD-NCDs) are driven by systemic inflammation, BBB disruption, and chronic hypoxia, affecting up to 61% of COPD patients and worsening outcomes.
• Mesenchymal stem cell-derived exosomes (MSC-Exos) offer a novel cell-free therapy with advantages such as non-immunogenicity, high stability, and ability to cross the BBB.
• MSC-Exos can modulate neuroinflammation, promote neurogenesis, enhance myelination, and improve synaptic plasticity, addressing multifaceted CNS pathogenesis.
• Future research must focus on large-scale production, long-term safety, and clinical translation to realize the therapeutic potential of MSC-Exos for COPD-NCDs.