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    Relationship between diffusion capacity and small airway abnormality in COPDGene. Criner Rachel N,Hatt Charles R,Galbán Craig J,Kazerooni Ella A,Lynch David A,McCormack Meredith C,Casaburi Richard,MacIntyre Neil R,Make Barry J,Martinez Fernando J,Labaki Wassim W,Curtis Jeffrey L,Han Mei Lan K Respiratory research Impaired single breath carbon monoxide diffusing capacity (DLCO) is associated with emphysema. Small airways disease (SAD) may be a precursor lesion to emphysema, but the relationship between SAD and DLCO is undescribed. We hypothesized that in mild COPD, functional SAD (fSAD) defined by computed tomography (CT) and Parametric Response Mapping methodology would correlate with impaired DLCO. Using data from ever-smokers in the COPDGene cohort, we established that fSAD correlated significantly with lower DLCO among both non-obstructed and GOLD 1-2 subjects. The relationship between DLCO with CT-defined emphysema was present in all GOLD stages, but most prominent in severe disease. TRIAL REGISTRATION: NCT00608764. Registry: COPDGene. Registered 06 February 2008, retrospectively registered. 10.1186/s12931-019-1237-1