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Little is known about factors associated with emphysema progression in cigarette smokers. We evaluated factors associated with change in emphysema and FEV1 in subjects with and without chronic obstructive pulmonary disease (COPD). This retrospective study included subjects participating in the COPDGene study and who completed the 5-year follow-up, including inspiratory and expiratory computed tomography (CT) and spirometry. All paired CT scans were analyzed using micro-mapping, which classifies individual voxels as emphysema or functional