Inclusion Criteria:  GOLD 0 participants shall be ages 30-55 years; and have: ≥ 10 pack-year smoking history; post-bronchodilator FEV1/FVC > 0.70 and FEV1 > 80% predicted; and COPD Assessment Test (CAT) score ≥ 10. Preserved Ratio Impaired Spirometry (PRISm) participants shall be between ages 30-55 years; and have: ≥ 10 pack-year smoking history; post-bronchodilator FEV1 < 80% predicted FEV1/FVC > 0.70. GOLD 1-2 participants shall be between ages 30-55 years, and have: ≥ 10 pack-year smoking history; post-bronchodilator FEV1/FVC < 0.70 and FEV1 50-80% predicted.  Exclusion Criteria:  Severe asthma, which is defined as any of the following:  Current (i.e., at the time of the visit) GINA Step 4 or higher therapy (medium dose ICS/LABA or high dose ICS or add-on LAMA; Medium dose = >250 fluticasone propionate =100 fluticasone furoate, >200 beclomethasone, >400 budesonide, >220 mometasone). We will accept low-dose ICS/LABA or medium dose ICS.  or 3 or more unscheduled healthcare visits (provider/urgent care/ER) for asthma in the past 12 months or One asthma hospitalization in the past 12 months  Concurrent participation in a therapeutic trial where treatment is blinded. Active pregnancy at the time of the baseline or return visits. This special population is being excluded to minimize potential for fetal radiation exposure. Cognitive dysfunction that prevents the participant from completing study procedures. BMI > 35.0 kg/m2 at baseline, due to the effects of body weight on CT scan imaging quality. The presence of a respiratory condition other than COPD or asthma, or of a comorbid condition that in the judgment of the investigator may be the principal cause of respiratory symptoms (e.g., dyspnea or decreased exercise tolerance). Any illness expected to cause mortality in the next 3 years. Any implanted metallic devices or prosthesis above the waist that could degrade thoracic CT scan image quality. History of thoracic radiation or thoracic surgery with resection of lung tissue