Abstract
Preserved ratio impaired spirometry (PRISm) is a heterogeneous condition but its course and disease progression remain to be elucidated. We aimed to examine its prevalence, trajectories and prognosis in the general population.
In the Rotterdam Study (population-based prospective cohort) we examined prevalence, trajectories and prognosis of subjects with normal spirometry (controls; forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥0.7, FEV1 ≥80%), PRISm (FEV1/FVC ≥0.7, FEV1 <80%) and chronic obstructive pulmonary disease (COPD) (FEV1/FVC <0.7) at two study visits. Hazard ratios with 95% confidence intervals for mortality (until December 30, 2018) were adjusted for age, sex, body mass index, current smoking and pack-years.
Of 5487 subjects (age 69.1±8.9 years; 7.1% PRISm), 1603 were re-examined after 4.5 years. Of the re-examined PRISm subjects, 15.7% transitioned to normal spirometry and 49.4% to COPD. Median lung function decline was highest in subjects with incident PRISm (FEV1 −92.8 mL·year−1, interquartile range (IQR) −131.9– −65.8 mL·year−1; FVC −93.3 mL·year−1, IQR −159.8– −49.1 mL·year−1), but similar in persistent PRISm (FEV1 −30.2 mL·year−1, IQR −67.9– −7.5 mL·year−1; FVC −20.1 mL·year−1, IQR −47.7–21.7 mL·year−1) and persistent controls (FEV1 −39.6 mL·year−1, IQR −64.3–−12.7 mL·year−1; FVC −20.0 mL·year−1, IQR −55.4–18.8 mL·year−1). Of 5459 subjects with informed consent for follow-up, 692 (12.7%) died during 9.3 years (maximum) follow-up: 10.3% of controls, 18.7% of PRISm subjects and 20.8% of COPD subjects. Relative to controls, subjects with PRISm and COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2–4 had increased all-cause mortality (PRISm: HR 1.6, 95% CI 1.2–2.0; COPD GOLD 2–4: HR 1.7, 95% CI 1.4–2.1) and cardiovascular mortality (PRISm: HR 2.8, 95% CI 1.5–5.1; COPD 2–4: HR 2.1, 95% CI 1.2–3.6). Mortality within <1 year was highest in PRISm, with patients often having cardiovascular comorbidities (heart failure or coronary heart disease; 70.0%).
PRISm is associated with increased mortality and this population encompasses at least three distinct subsets: one that develops COPD during follow-up, a second with high cardiovascular burden and early mortality, and a third with persistent PRISm and normal age-related lung function decline.
Abstract
Preserved ratio impaired spirometry, previously called restrictive spirometry, is a condition associated with increased mortality that encompasses distinct clinical subsets http://bit.ly/2ncclac
Footnotes
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Conflict of interest: S.R.A. Wijnant reports grants from GalaxoSmithKline (award), outside the submitted work.
Conflict of interest: E. de Roos has nothing to disclose.
Conflict of interest: M. Kavousi has nothing to disclose.
Conflict of interest: B.H. Stricker has nothing to disclose.
Conflict of interest: N. Terzikhan has nothing to disclose.
Conflict of interest: L. Lahousse reports grants from AstraZeneca and Chiesi (both awards), and expert consultation for Boehringer Ingelheim and Novartis, outside the submitted work.
Conflict of interest: G.G. Brusselle reports personal fees from AstraZeneca (advisory boards and lecture fees), Boehringer Ingelheim (advisory boards and lecture fees), Chiesi (advisory boards and lecture fees), GlaxoSmithKline (advisory boards and lecture fees), Novartis (advisory boards and lecture fees), Sanofi (advisory boards) and Teva (advisory boards and lecture fees), outside the submitted work.
Support statement: This research was funded by the “Funds for Scientific Research Flanders (Fonds voor Wetenschappelijk Onderzoek Vlaanderen)”, grant number 3G037618. The Rotterdam Study is supported by the Erasmus MC and Erasmus University Rotterdam; the Netherlands Organisation for Scientific Research (NWO) (grant no. 918-46-615); the Netherlands Organisation for Health Research and Development (ZonMW); the Research Institute for Diseases in the Elderly (RIDE); the Netherlands Genomics Initiative; the Ministry of Education, Culture and Science; the Ministry of Health, Welfare and Sports; the European Commission (DG XII; grant no. 601055); and the Municipality of Rotterdam. The funding sources had no involvement in the collection, analysis, writing, interpretation or the decision to submit the paper for publication. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received June 20, 2019.
- Accepted September 20, 2019.
- Copyright ©ERS 2020