text: Individuals with undiagnosed respiratory symptoms, 
  determined to have asthma or COPD through 
  spirometry, experience poor health status.28 Therefore, 
  the implementation of known treatment approaches for 
  asthma or COPD is important to improve their 
  conditions.29 In contrast, those with normal spirometry 
  or PRISm face unclear treatment approaches. Long- 
  acting BD therapy in symptomatic individuals with 
  tobacco exposure with normal spirometry is not 
  effective.30 Weight management programs may be useful 
  for individuals who are obese with PRISm-related 
  dyspnea; however, this awaits deﬁnitive clinical trials.31  In conclusion, our study measured dyspnea impact in 
  individuals with no preexisting diagnosis of lung disease 
  who reported respiratory symptoms as part of a 
  purposeful case ﬁnding strategy. Individuals with PRISm 
  exhibited the greatest impact of dyspnea, even higher 
  than those newly diagnosed with asthma or COPD. 
  After adjusting for patient factors, comorbidities, 
  pulmonary diseases, and severity of lung physiologic 
  impairment, most of the variability in dyspnea remained 
  unexplained. We also showed that dyspnea was 
  associated with increased health care utilization, 
  impaired quality of life, and work productivity. 