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Am J Respir Crit Care Med. 2018 Jun 6. doi: 10.1164/rccm.201804-0663OC. [Epub ahead of print]

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

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Brigham & Women's Hospital, Channing Division of Network Medicine, Boston, Massachusetts, United States.
VA Boston Health Care System Jamaica Plain Campus, 20025, Boston, Massachusetts, United States ;
University of Iowa Hospitals and Clinics, 21782, Division of Pulmonary, Critical Care and Occupation Medicine, Iowa City, Iowa, United States.
National Jewish Health, Department of Medicine, Denver, Colorado, United States.
University of Colorado Anschutz Medical Campus, Epidemiology, Aurora, Colorado, United States.
University of Michigan, Internal Medicine, Ann Arbor, Michigan, United States.
Harbor-UCLA Medical Center, Torrance, California, United States.
National Jewish Health, Denver , Colorado, United States.
National Jewish Medical & Research Ctr., Denver, Colorado, United States.
Brigham and Womens, Boston, Massachusetts, United States.
Brigham and Women's Hospital, Channing Division of Network Medicine, Boston, Massachusetts, United States.
Brigham and Women's Hospital, Division of Pulmonary Critical Care Medicine, Boston, Massachusetts, United States.


Rationale/Objective Increasing awareness of the prevalence and significance of Preserved Ratio Impaired Spirometry (PRISm), alternatively known as "restrictive" or "GOLD-Unclassified" spirometry, has expanded the body of knowledge on cross-sectional risk factors. However, longitudinal studies of PRISm remain limited. Methods/Measurements Current and former smokers, age 45-80, 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 CT 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 (FEV1/FVC<0.7 & FEV1<80%), GOLD0 (FEV1/FVC>0.7 & FEV1>80%), and GOLD1-4 (FEV1/FVC<0.7). Results 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 while 25.1% progressed to GOLD1-4 at Phase 2. Subjects with PRISm at both Phase 1 and Phase 2 had reduced rates of FEV1 decline (-27.3±42.1 versus -33.0±41.7 mL/year) and comparable proportions of normal CT scans (51% versus 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. Conclusions PRISm is highly prevalent, associated with increased mortality, and represents a transitional state for significant subgroups of subjects. Additional studies to characterize longitudinal progression in PRISm are warranted.


Lung Diseases – Epidemiology; Spirometry – Mortality; Spirometry – Statistics &amp; Numerical Data; Spirometry-Classification


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