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We do see patients with COPD having various grades of clubbing. Most of them (>95%) do not show any evidence of lung cancer or associated ILD on X-ray or HRCT. All of these patients had low SpO2 and low DLCO. Probably chronic hypoxia leads to clubbing in COPD patients. Interestingly I never saw a severe Asthma patient with chronic hypoxia developing clubbing.

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