Volume 154, Issue 6, Pages 1278-1281 (December 2018) COUNTERPOINT: Should Chest CT Be Part of Routine Clinical Care for COPD? No  MeiLan K. Han, MD  CHEST  Volume 154, Issue 6, Pages 1278-1281 (December 2018) DOI: 10.1016/j.chest.2018.08.1057 Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 1 Distribution of participants from the Framingham Offspring Cohort and Copenhagen City Heart Study demonstrating four lung function trajectories, T1 to T4, defined according to baseline level of FEV1 (below or above 80% of predicted value) and presence or absence of GOLD grade > 2 COPD at the final examination.10 The solid lines represent the schematic natural history of FEV1 for the age range of those studied, whereas the broken lines represent hypothetical trajectories. The line in red indicates individuals who experienced rapid decline in COPD and are likely to be most amenable to disease-modifying therapies as opposed to those represented by the blue line, who began with lower adult lung function but experienced less rapid decline. GOLD = Global Initiative for Chronic Obstructive Lung Disease. CHEST 2018 154, 1278-1281DOI: (10.1016/j.chest.2018.08.1057) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 2 A and B, Plots of average deaths per 100 person-years by percent emphysema in COPDGene (A) and SPIROMICS (B). Blue dots represent raw averages for death rates grouped by nearest emphysema percentile. Age-adjusted estimates for average deaths per 100 person-years shown via linear splines in blue (using every percentile of emphysema) and in red (smoothed). C and D, Plots of mean exacerbations per year by percent emphysema in COPDGene (C) and SPIROMICS (D). Blue dots represent raw averages for exacerbation rates grouped by nearest emphysema percentile. Age-adjusted estimates for average exacerbations per year shown via linear splines in blue (using every percentile of emphysema) and in red (smoothed).16 COPDGene = Genetic Epidemiology of COPD; SPIROMICS = Subpopulations and Intermediate Outcome Measures in COPD Study. CHEST 2018 154, 1278-1281DOI: (10.1016/j.chest.2018.08.1057) Copyright © 2018 American College of Chest Physicians Terms and Conditions