Taking all of the above into account, it is conceivable to envisage that the ideal COPD natural history study, as Vestbo suggested in the article by Mannino et al,42 should be an enlarged pulmonary version of the Framingham Study, enabling us to do what cardiologists have already done. In addition, it should take into account our knowledge (or lack of knowledge) on genetics and the early origin of late-onset disease. From this somewhat naive viewpoint, the ideal COPD natural history study should be large; start before birth; include follow-up for life; include a few hundred pages of questionnaire forms, PFT, biomarker measurements (including imaging), and direct exposure measures, and, of course, genetics and all the “omics” (eg, genomics, proteomics, metabolomics).45 Obviously, this is not an easy task. An alternative might be pooling results from individual natural history studies, and using a metaanalytical approach could be a partial, positive solution, as has been proposed46 for asthma and atopy birth cohorts, and is currently being explored for lung function and COPD. As a consequence, the ideal COPD natural history study might consist of multiple studies, each addressing a specific scientific question.