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Correspondence
Spirometric thresholds and biased interpretation of test results
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  1. Philip H Quanjer1,2,
  2. Sanja Stanojevic3,
  3. Bruce R Thompson4
  1. 1 Department of Pulmonary Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
  2. 2 Department of Paediatrics, Division Respiratory Medicine, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
  3. 3 Division of Respiratory Medicine, The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  4. 4 Allergy 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

https://doi.org/10.1136/thoraxjnl-2014-206089

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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.

    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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