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Longitudinal Phenotypes and Mortality in Preserved Ratio Impaired Spirometry in the COPDGene Study
Journal article   Open access   Peer reviewed

Longitudinal Phenotypes and Mortality in Preserved Ratio Impaired Spirometry in the COPDGene Study

Emily S Wan, Spyridon Fortis, Elizabeth A Regan, John Hokanson, MeiLan K Han, Richard Casaburi, Barry J Make, James D Crapo, Dawn L DeMeo, Edwin K Silverman, …
American journal of respiratory and critical care medicine, Vol.198(11), pp.1397-1405
12/01/2018
DOI: 10.1164/rccm.201804-0663OC
PMCID: PMC6290948
PMID: 29874098
url
https://doi.org/10.1164/rccm.201804-0663OCView
Published (Version of record) Open Access

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Abstract

Increasing awareness of the prevalence and significance of Preserved Ratio Impaired Spirometry (PRISm), alternatively known as restrictive or Global Initiative for Chronic Obstructive Lung Disease (GOLD)-unclassified spirometry, has expanded the body of knowledge on cross-sectional risk factors. However, longitudinal studies of PRISm remain limited. To examine longitudinal patterns of change in lung function, radiographic characteristics, and mortality of current and former smokers with PRISm. Current and former smokers, aged 45 to 80 years, were enrolled in COPDGene (phase 1, 2008-2011) and returned for a 5-year follow-up (phase 2, 2012-2016). Subjects completed questionnaires, spirometry, chest computed tomography scans, and 6-minute-walk tests at both study visits. Baseline characteristics, longitudinal change in lung function, and mortality were assessed by post-bronchodilator lung function categories: PRISm (FEV /FVC < 0.7 and FEV  < 80%), GOLD0 (FEV /FVC > 0.7 and FEV  > 80%), and GOLD1-4 (FEV /FVC < 0.7). Although the prevalence of PRISm was consistent (12.4-12.5%) at phases 1 and 2, subjects with PRISm exhibited substantial rates of transition to and from other lung function categories. Among subjects with PRISm at phase 1, 22.2% transitioned to GOLD0 and 25.1% progressed to GOLD1-4 at phase 2. Subjects with PRISm at both phase 1 and phase 2 had reduced rates of FEV decline (-27.3 ± 42.1 vs. -33.0 ± 41.7 ml/yr) and comparable proportions of normal computed tomography scans (51% vs. 52.7%) relative to subjects with stable GOLD0 spirometry. In contrast, incident PRISm exhibited accelerated rates of lung function decline. Subjects with PRISm at phase 1 had higher mortality rates relative to GOLD0 and lower rates relative to the GOLD1-4 group. PRISm is highly prevalent, is associated with increased mortality, and represents a transitional state for significant subgroups of subjects. Additional studies to characterize longitudinal progression in PRISm are warranted.
 Phenotype Pulmonary Disease, Chronic Obstructive - diagnosis United States - epidemiology Follow-Up Studies Respiratory Function Tests - statistics & numerical data Humans Middle Aged Risk Factors Respiratory Function Tests - methods Smokers - statistics & numerical data Male Lung - physiopathology Pulmonary Disease, Chronic Obstructive - physiopathology Pulmonary Disease, Chronic Obstructive - epidemiology Spirometry - methods Aged, 80 and over Female Surveys and Questionnaires Aged Longitudinal Studies

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