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In an effort to elucidate what constitutes irreversible airways obstruction (ie, COPD), Bhatt et al 1 used CT-defined emphysema and gas trapping to determine whether a fixed FEV1:FVC ratio or the lower limit of normal (LLN) is a clinically more discriminating index of COPD. There are, however, several methodological limitations that need to be considered when interpreting these results.
The study assumes a paradigm that radiographic signs of emphysema and/or air trapping are specific of COPD. Alterations in pulmonary …