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Airways dysanapsis, a mismatch between airway calibre and lung volume, has long been observed as a physiological variant first described in healthy individuals by Green and Mead in the 1970s.1 While initially a conceptual curiosity, the phenomenon has evolved into a biomarker of potential clinical importance, particularly in the context of obstructive lung diseases like asthma and chronic obstructive pulmonary disease (COPD). However, its true significance, especially when defined by spirometry rather than anatomical imaging, has remained unclear. In their study published in this issue of Thorax, Smith and colleagues2 provide new insights using advanced functional imaging techniques, demonstrating that spirometric dysanapsis is associated with measurable lung pathology.