Do you prescribe bronchodilators to patients with radiographic emphysema and respiratory symptoms, but no spirometric obstruction?

Yes, I will sometimes offer a therapeutic trial of bronchodilators to symptomatic patients with radiographic emphysema, but no obstruction on spirometry. Patients with CT evidence of emphysema were not specifically studied in the RETHINC trial.

Individuals with a pre-COPD phenotype have normal spirometry, including the FEV1 and FEV1/FVC ratio, but have functional and/or structural changes concerning COPD, such as air trapping or hyperinflation, impaired diffusion capacity, or accelerated decline in FEV1 of more than 40 cc/year.

Structural ...