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We thank Dr Kotz and colleagues for their interest in our investigations and look forward to the results of their study.1 Our study did not confirm the opinion that spirometric tests showing normal lung function would encourage smokers to continue to smoke. We are aware that our investigations were not randomised and pointed this out in the discussion. This weakness was also stressed in the accompanying editorial by Mannino.2
With regard to possible bias introduced by the use of pharmacological treatment by smokers in our study during 1 year of follow‐up, we would like to repeat that (1) in the study protocol smokers were asked to use their own motivation only to stop smoking and not to take pharmacological treatment, and (2) during the follow‐up visit all subjects confirmed compliance with the protocol. Although we cannot exclude the possibility that deviation from the protocol may have occurred in some cases, it seems unlikely. Pharmacological treatment of nicotine dependence is not reimbursed and is relatively expensive in Poland. Bupropion is on prescription and only nicotine replacement therapy is available over the counter.
The suggestion that approaching younger smokers would be more rewarding is worth exploring. In our experience, airway obstruction is much less frequent (10%) in smokers aged 35–40 years than in older age groups. Since younger smokers are also less inclined to stop smoking, perhaps smoking cessation clinics would be more cost effective for this group than spirometric testing.