This study introduces a novel approach to size-based emphysema clustering, evaluating the size variation and collapse of holes in emphysema clusters using inspiratory and expiratory computed tomography (CT). The researchers developed a new method for the size differentiation of emphysema holes, which was applied to the volumetric CT results of emphysema patients. The study found significant correlations between blind visual evaluations and the classification using the size-based emphysema clustering method. Furthermore, the collapse of emphysema holes was found to be significantly correlated with pulmonary function test parameters. The study concluded that a detailed assessment of the size variation and collapse of emphysema holes could provide useful insight into the dynamic collapse of emphysema and its functional relationship. The methodology developed in this research has been commercialized in AVIEW COPD by Coreline Soft, offering a new tool for understanding and managing emphysema.