Association Between Preserved Ratio Impaired Spirometry and Clinical Outcomes in US Adults

Abstract

IMPORTANCE Chronic lung diseases are a leading cause of morbidity and mortality. Unlike chronic obstructive pulmonary disease, clinical outcomes associated with proportional reductions in expiratory lung volumes without obstruction, otherwise known as preserved ratio impaired spirometry (PRISm), are poorly understood. OBJECTIVE To examine the prevalence, correlates, and clinical outcomes associated with PRISm in US adults. DESIGN, SETTING, AND PARTICIPANTS The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study was a retrospective study with harmonized pooled data from 9 US general populationbased cohorts (enrollment, 65 251 participants aged 18 to 102 years of whom 53 701 participants had valid baseline lung function) conducted from 1971-2011 (final follow-up, December 2018).EXPOSURES Participants were categorized into mutually exclusive groups by baseline lung function. PRISm was defined as the ratio of forced expiratory volume in the first second to forced vital capacity (FEV 1 :FVC) greater than or equal to 0.70 and FEV 1 less than 80% predicted; obstructive spirometry FEV 1 :FVC ratio of less than 0.70; and normal spirometry FEV 1 :FVC ratio greater than or equal to 0.7 and FEV 1 greater than or equal to 80% predicted. MAIN OUTCOMES AND MEASURESMain outcomes were all-cause mortality, respiratory-related mortality, coronary heart disease (CHD)-related mortality, respiratory-related events (hospitalizations and mortality), and CHD-related events (hospitalizations and mortality) classified by adjudication or validated administrative criteria. Absolute risks were adjusted for age and smoking status. Poisson and Cox proportional hazards models comparing PRISm vs normal spirometry were adjusted for age, sex, race and ethnicity, education, body mass index, smoking status, cohort, and comorbidities.

Quality Standard Position Statements for Health System Policy Changes in Diagnosis and Management of COPD: A Global Perspective

“…Healthcare practitioners also should recognize that while 17–24% of patients with preserved lung function may not fulfill the spirometry criterion for a diagnosis of COPD [ 39 ], they may nonetheless experience respiratory symptoms, exacerbation-like events, and activity limitations with some evidence of airway disease [ 40 ]. Notably, a subset of patients with preserved ratio impaired spirometry (PRISm) eventually progress to meet the spirometric criterion for COPD and are at increased risk of respiratory symptoms, respiratory exacerbations, and mortality [ 41 – 43 ]. Currently, however, GOLD recommendations do not address the therapeutic management of patients with PRISm, who represent a heterogenous population, that is possibly underdiagnosed and underappreciated.…”

The prevalence and physiological impacts of centrilobular and paraseptal emphysema on computed tomography in smokers with preserved ratio impaired spirometry

“…Preserved ratio impaired spirometry (PRISm), defined as reduced forced expiratory volume in 1 s (FEV 1 ) without airflow limitation on spirometry, is increasingly recognised as a major nonobstructive spirometry disorder [1]. The prevalence of PRISm is 7.1-12.5% in adults [2][3][4] and the presence of PRISm is associated with higher risk of mortality in never-and ever-smokers [2,4]. In smokers, PRISm is also considered the transitional state to COPD that is characterised by airflow limitation on spirometry and persistent respiratory symptoms [2,5].…”

Association of 71 cardiovascular disease-related plasma proteins with pulmonary function in the community

“…While associations between CVD and pulmonary diseases have been well established, there is growing evidence that subtle changes in spirometry indices of lung function, even within the normal range, are predictive of risk for future cardiac disease [ 21 ]. In particular, reductions in FEV 1 and FVC with a preserved FEV 1 /FVC (consistent with restrictive lung changes) in a young ostensibly healthy cohort was reported to be associated with adverse cardiac remodeling, increased left ventricular wall thickness, left ventricular mass, and increased odds of diastolic dysfunction [ 21 , 22 ]. The association of FVC with increased CVD risk has been demonstrated in the FHS, with early studies reporting a lower FVC to be associated with risk of heart failure and CVD mortality [ 8 ].…”