We agree with Drs Robberts and Schermer that the important “million-dollar question” is how to confidently detect the susceptible smokers who will subsequently develop clinically important COPD if they continue smoking. As shown by results from the Lung Health Study7 in middle-aged smokers with FEV1/FVC <0.70 (see Figure 2 in our counterpoint editorial1), those with an FEV1 >70%, a threshold close to the lower limit of normal for FEV1, had a mean subsequent loss of FEV1 near normal (−1.2% per year). Only below the middle of GOLD stage 2 was the mean annual loss of FEV1 relatively rapid. However, there was a very wide variation, so the predictive power was very low even when all baseline characteristics of the smokers were considered in a multivariate model (R2 =0.10). Other cohort studies have collected longitudinal data from large numbers of smoking adults, including those >65 years of age, and we encourage them to similarly analyze these data. We eagerly await new genetic and biochemical markers, which will begin to clear the smoke in our prophetic crystal ball. It is actually more like a $5 billion (or Euro) question, since that is the current worldwide COPD inhaler market, which would greatly expand if we could confidently predict who is developing COPD and had a drug to substantially dampen the progression of COPD in these susceptible smokers. Don’t hold your breath.