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  1. David M Mannino1,
  2. A Sonia Buist2,
  3. William M Vollmer3
  1. 1
    Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
  2. 2
    Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
  3. 3
    Kaiser Permanente Center for Health Research, Portland, Oregon, USA
  1. Dr David M Mannino, Division of Pulmonary and Critical Care Medicine, University of Kentucky Medical Center, 740 S Limestone, K-528, Lexington, Kentucky 40536, USA; dmannino{at}uky.edu

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We thank Drs Enright, Miller and Petsonk et al for their insightful comments regarding our recently published paper.1 Their concerns can be summarised as follows: (1) use of the fixed forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio of 0.70 rather than a lower limit of normal greatly “overdiagnoses” chronic obstructive pulmonary disease (COPD) and is thus detrimental to both public health and the psychological health of patients; (2) GOLD stage I COPD does not represent disease but is, in most people, simply normal ageing; and (3) our measure of “COPD-related hospitalisations” probably included many hospitalisations not caused by COPD.

While we recognise the potential for overdiagnosis posed by use of the GOLD fixed ratio criterion, historically the greater public health problem has been the underdiagnosis (and corresponding undertreatment) of COPD, especially lung function impairment that clinicians would consider …

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