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GOLD guidelines establish recommendations for patients with impaired lung function but do not include recommendations on how to evaluate individuals with risk factors or individuals who, without meeting COPD spirometric criteria, have a decline in lung function that inevitably leads to the establishment of the disease with the onset of symptoms and limitations in their daily activities

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ACKNOWLEDGMENTS I would like to acknowledge my mother for her commitment to health and good nutrition more than fifty years ago, and all of the teachers, researchers, and scientists who over the years instilled in me a love of scientific inquiry