These biomarkers (AGER, ICAM1 and CCL20) were associated with emphysema regardless of quantification technique (%LAA ≤ −950 and ≤ −910 HU and LP15A) and were replicated in an independent COPD cohort (TESRA), thus strengthening their potential utility for defining clinically relevant emphysema. Here, CCL20 is linked to chronic obstructive pulmonary disease.