A secondary data analysis of the CARDIA (Coronary Artery Risk Development In Young Adults) Lung study found that emphysema is often detectable on CT scan before spirometry findings become abnormal. The findings suggest that reliance on spirometry alone may result in the underrecognition of impaired respiratory health. Because the discrepancy is particularly present in Black men, this could exacerbate racial disparities. The analysis is published in Annals of Internal Medicine.