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A 53-year-old man presents to the clinic with complaints of increasing shortness of breath, a nagging cough, and weight loss over several months. He reports no history of cigarette smoking but has worked underground in the New York City subway system for the past 20 years. Spirometry tests are ordered that demonstrate a forced expiratory volume in 1 second:forced vital capacity ratio (FEV1:FVC) of 0.7, and an FEV1 value that is 60% of expected. The FEV1 improves to 70% of expected with bronchodilator treatment. Which of the following is the most likely diagnosis?
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