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Correspondence
Spirometric thresholds and biased interpretation of test results
  1. Philip H Quanjer1,2,
  2. Sanja Stanojevic3,
  3. Bruce R Thompson4
  1. 1Department of Pulmonary Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
  2. 2Department of Paediatrics, Division Respiratory Medicine, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
  3. 3Division of Respiratory Medicine, The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  4. 4Allergy Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Australia
  1. Correspondence to Dr Philip H Quanjer, Department of Pulmonary Diseases, Erasmus University Medical Centre, Rotterdam 3015 CD, The Netherlands, and Department of Paediatrics, Division Respiratory Medicine, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands; pquanjer{at}gmail.com

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In an effort to elucidate what constitutes irreversible airways obstruction (ie, COPD), Bhatt et al1 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.

  1. The study assumes a paradigm that radiographic signs of emphysema and/or air trapping are specific of COPD. Alterations in pulmonary …

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