Parekh TM, Bhatia S, Cherrington A, et al. - Researchers investigated whether the reduction in quality of life (QoL) among normal spirometry and Preserved Ratio Impaired Spirometry (PRISm) participants in COPDGene (a multicenter, longitudinal investigation in the US meant to recognize genetic determinants of COPD) could be predicted by exacerbations and change in exacerbation status. Multivariable logistic regression models were used to define independent predictors of a drop in QoL [> 4 points on the St George's Respiratory Questionnaire]. For current and former smokers with normal spirometry and PRISm, separate analyses were carried out. The factors that independently predicted QoL decline were: current smoking, higher exacerbation frequency, and a shift from infrequent to frequent exacerbation status in both groups. Overall, QoL deterioration in smokers with normal spirometry and PRISm was predicted by continued smoking and the onset of frequent exacerbations.