Abstract
Cutting the Gordian knot, as attributed to Alexander the Great, is a metaphor for solving seemingly intractable problems by finding a simple, straightforward solution. Agreeing on a universal operational definition of chronic obstructive pulmonary disease, and the spirometric thresholds to confirm it, has been an almost impossible task. Physiologists, clinicians, epidemiologists, other health and non-health professionals, as well as respiratory, internal medicine, and primary care societies, and patients themselves, have been unable to fully agree on seemingly simple concepts.
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