Inclusion Criteria:  Age ≥18 years. The participant or his / her legal representative is willing and able to give informed consent to participate in the study. Female or male patients with age equal to or greater than 18 years. Smokers or ex-smokers with cumulative exposure ≥ 10 a / p Respiratory symptoms Normal spirometry.  Exclusion Criteria:  Age under 18 years. Participation in another clinical study. Patients with a life expectancy of less than 2 years due to neoplasms or other serious systemic diseases. Refusal to sing informed consent.