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The additional examinations consisted of PFT and computed tomography (CT) to detect COPD and radiological emphysema. The diagnosis was recorded by the examining physicians at the secondary centres. The primary end-points of this study were the detection rate of COPD and identifying the distribution of COPD severity. The study protocol was approved by the committee of the Chiba COPD Lung Cancer Screening Study Group, and each participating hospital and clinic. The screening system of Chiba City, Japan, the 13th largest city with approximately 960?000 inhabitants, was used for the study. The number of residents eligible for screening in Chiba City was 258?478 in the 2010 fiscal year. From April 2010 to March 2011, 89?100 residents (34.5%) underwent chest radiography at 257 clinics and hospitals. Of these, 72?653 residents were 60 years of age or older. Chiba City has 39 secondary evaluation centres certified to diagnose pulmonary diseases. The diagnostic categories included the Vatalanib (PTK787) 2HCl following: no abnormality, lung cancer (including suggestive findings), metastatic lung tumour, mediastinal tumour, tuberculosis, COPD/emphysema and others. The diagnosis of COPD was based on PFT, and the diagnosis of emphysema was based on CT findings. During the secondary evaluation, the evaluating physicians at the secondary centres LY2835219 molecular weight determined the severity of COPD and made the following recommendations: no treatment and no follow-up, annual follow-up without treatment, and treatment. To verify the reliability of the diagnoses reported from the secondary evaluation centres, Abiraterone the clinical data (PFT and/or CT) of 228 residents who had provided written informed consent were collected from the secondary centres and evaluated by the authors, and the authors' assessments were compared with the diagnoses of the evaluating physicians. A total of 173 participants underwent PFT and 185 underwent CT. The PFT diagnosis of COPD was based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging.[15] The functional criterion for COPD was the following: forced expiratory volume in 1?s (FEV1)/forced vital capacity (FVC) less than 70%. The severity of radiological emphysema was visually assessed by two independent pulmonologists according to the modified Goddard scoring system.[16, 17] Six images of three lung slices (the right and left lungs were evaluated separately) were analyzed for each participant. Each image was classified and scored as follows: normal (score 0), ��?5% affected (score 0.5), ��?25% affected (score 1), ��?50% affected (score 2), ��?75% affected (score 3) and >75% affected (score 4), and the mean score of six images was considered to be representative of the severity of emphysema. The participants were then classified into three groups based on the severity of emphysema: (i) no/mild emphysema (emphysema score?