Persistent Empiric COPD Diagnosis and Treatment After Pulmonary Function Test Showed No Obstruction

Fortis, Spyridon; Corazalla, Edward; Jacobs, David R.; Kim, Hyun J

doi:10.4187/respcare.04647

Cited by 11 publications

(16 citation statements)

References 28 publications

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“…PRISm is a common spirometric pattern with a prevalence between 5% and 20% [22][23][24][25] . Although often referred to as a "restrictive spirometric pattern", 30-40% of patients with PRISm do not have reduced TLC 26,27 . On average, individuals PRISm have higher BMI, but obesity alone does not decrease vital capacity or TLC below the LLN in most individuals 28 .…”

Section: Discussionmentioning

confidence: 99%

Low FVC/TLC in Preserved Ratio Impaired Spirometry (PRISm) is associated with features of and progression to obstructive lung disease

Fortis

Comellas

Kim

et al. 2020

Sci Rep

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One quarter of individuals with Preserved Ratio Impaired Spirometry (PRISm) will develop airflow obstruction, but there are no established methods to identify these individuals. We examined the utility of FVC/TLC in identifying features of obstructive lung disease. The ratio of post-bronchodilator FVC and tLc ct from chest ct (fVc/tLc ct) among current and former smokers with pRiSm (feV 1 /fVc ≥ 0.7 and FEV1 < 80%) in COPDGene was used to stratify subjects into quartiles: very high, high, low, and very low. We examined the associations between FVC/TLC ct quartiles and (1) baseline characteristics, (2) respiratory exacerbations, (3) progression to COPD at 5 years, and (4) all-cause mortality. Among participants with pRiSm at baseline (n = 1,131), the very low FVC/TLC ct quartile was associated with increased gas trapping and emphysema, and higher rates of progression to COPD at 5 years (36% versus 17%; p < 0.001) relative to the very high quartile. The very low FVC/TLC ct quartile was associated with increased total (iRR = 1.65; 95% CI [1.07-2.54]) and severe (IRR = 2.24; 95% CI [1.29-3.89]) respiratory exacerbations. Mortality was lower in the very high FVC/TLC ct quartile relative to the other quartiles combined. Reduced FVC/TLC ct ratio in PRISm is associated with increased symptoms, radiographic emphysema and gas trapping, exacerbations, and progression to COPD.

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Section: Discussionmentioning

confidence: 99%

Low FVC/TLC in Preserved Ratio Impaired Spirometry (PRISm) is associated with features of and progression to obstructive lung disease

Fortis

Comellas

Kim

et al. 2020

Sci Rep

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“…Our previous work indicated that isolated reduction in FEV 1 was only 4.7% of all abnormal nonobstructed spirometries. 7 In this cohort, prevalence did not vary whether PRISm was defined as FVC # lower limit of normal with FEV 1 /FVC $ lower limit of normal, or as FEV 1 # lower limit of normal with FEV 1 /FVC $ lower limit of normal. Other studies used spirometry before bronchodilator use, [1][2][3]11 and others used spirometry after bronchodilator use.…”

Section: Discussionmentioning

confidence: 61%

“…4,13 FEV 1 and FVC are concomitantly reduced, whereas an isolated reduction in FEV 1 or FVC is infrequent. 7,14 Iyer et al 14 reported that, among all abnormal nonobstructed spirometries, 85.5% had both reduced FEV 1 and FVC, whereas 11.2% had only low FEV 1 , and 3.3% had isolated low FVC. Our previous work indicated that isolated reduction in FEV 1 was only 4.7% of all abnormal nonobstructed spirometries.…”

Section: Discussionmentioning

confidence: 99%

“…6 In our previous work, which included only PFTs that met the American Thoracic Society criteria for acceptability and repeatability, we reported that 37.4% of all pre-bronchodilator spirometries and 57% of abnormal spirometries had PRISm. 7 Smoking exposure, high body mass index, and reduced TLC have been associated with PRISm among a cohort of smokers without interstitial lung disease. 8 The factors associated with PRISm in the clinical setting are not known.…”

Section: Introductionmentioning

confidence: 98%

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Preserved Ratio Impaired Spirometry in a Spirometry Database

et al. 2020

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BACKGROUND: Spirometry results can yield a diagnosis of normal air flow, air flow obstruction, or preserved ratio impaired spirometry (PRISm), defined as a reduced FEV 1 or FVC in the setting of preserved FEV 1 /FVC. Previous studies have estimated the prevalence of PRISm to be 7-12%. Our objective was to examine the prevalence of PRISm in a spirometry database and to identify factors associated with PRISm. METHODS: We performed a retrospective analysis of 21,870 spirometries; 1,616 were excluded because of missing data or extremes of age, height, or weight. We calculated the prevalence of PRISm in prebronchodilator and postbronchodilator pulmonary function tests. Subsequently, we calculated the prevalence of PRISm by various age, race, body mass index, and diagnosis categories, as well as by gender and smokers versus nonsmokers. Finally, in the subset of the cohort with FEV 1 < lower limit of normal, we performed a multivariable logistic regression analysis to identify factors associated with PRISm. RESULTS: We identified 18,059 prebronchodilator spirometries, and 22.3% of these yielded a PRISm diagnosis. This prevalence remained stable in postbronchodilator spirometries (17.7%), after excluding earlier pulmonary function tests for subjects with multiple pulmonary function tests (20.7% in prebronchodilator and 24.3% in postbronchodilator), and when we limited the analysis to prebronchodilator spirometries that met American Thoracic Society criteria (20.6%). The PRISm prevalence was higher in subjects 45-60 y old (24.4%) and in males (23.7%) versus females (17.9%). The prevalence rose with body mass index and was higher for those with a referral diagnosis of restrictive lung disease (50%). PRISm prevalence was similar between races and smokers versus nonsmokers. In a multivariable analysis, higher % of predicted FEV 1 (odds ratio 1.51, 95% CI 1.42-1.60), body mass index (odds ratio 1.52, 95% CI 1.39-1.68), and restrictive lung disease (odds ratio 4.32, 95% CI 2.54-7.57) were associated with a diagnosis of PRISm. Smoking was inversely associated (odds ratio 0.55, 95% CI 0.46-0.65) with PRISm. CONCLUSIONS: In a spirometry database at an academic medical center, the PRISm prevalence was 17-24%, which is higher than previously reported.

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“…The rest 36% have a nonspecific Pulmonary Function Test pattern. 4 Approximately, 15% of patients with this nonspecific PFT pattern develop OVD in follow-up PFTs. 4 It is possible that a portion of patients with obstructive lung disease remain underdiagnosed when FVC is used to compute FEV 1 /FVC ratio.…”

mentioning

confidence: 99%

Lost in interpretation: should the highest VC value be used to calculate the FEV<sub>1</sub>/VC ratio?

Fortis

2016

COPD

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Persistent Empiric COPD Diagnosis and Treatment After Pulmonary Function Test Showed No Obstruction

Abstract: Persistent empiric COPD diagnosis was 7%, but persistent empiric treatment was common.

Cited by 11 publications

References 28 publications

Low FVC/TLC in Preserved Ratio Impaired Spirometry (PRISm) is associated with features of and progression to obstructive lung disease

Low FVC/TLC in Preserved Ratio Impaired Spirometry (PRISm) is associated with features of and progression to obstructive lung disease

Preserved Ratio Impaired Spirometry in a Spirometry Database

Lost in interpretation: should the highest VC value be used to calculate the FEV<sub>1</sub>/VC ratio?

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