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Additional covariates for exacerbations included FEV 1 % predicted, SGRQ, and gastroesophageal reflux disease (GERD).18 , 19 Exacerbations in the year prior to enrollment (retrospective) and during longitudinal follow-up (prospective) were modeled using negative binomial regression with an offset for exposure time and zero-inflated negative binomial (ZINB) regression to account for the excess number of subjects who reported no acute episodes of respiratory disease (see18 for a description of modeling exacerbations)