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Letter
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We appreciate the issues raised by Dr Hoesein regarding our paper1 and respond as follows.
First, the NELSON study is a randomised screening trial for lung cancer and therefore targets subjects at high risk. The focus of our paper is different. We evaluated the prognostic meaning of a change in prebronchodilation spirometry—a common outcome in environmental epidemiology—in terms of respiratory health, not specifically bound to chronic obstructive pulmonary disease (COPD). We showed that this outcome has value in epidemiological research, but that understanding of the early stages of airflow obstruction, where non-persistence …