According to an editorial, these results confirm and extend the findings of another recent large study that showed more than 50% of symptomatic smokers with normal findings on spirometry have considerable respiratory-related impairment and evidence of emphysema on imaging. It notes that most of these symptomatic smokers with normal findings on spirometry are often treated (without any evidence) with inhaled bronchodilators and glucocorticoids, i.e. they are treated like patients with COPD, but they do not have COPD according to the current definition. The editorial concludes that these new studies help define this new cohort of patients with chronic respiratory symptoms without obstruction for which optimal treatment to reduce symptoms and prevent exacerbations remains to be established.