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

Rationale: 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. Objectives: To examine longitudinal patterns of change in lung function, radiographic characteristics, and mortality of current and former smokers with PRISm. Methods: 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 (FEV1/FVC < 0.7 and FEV1 < 80%), GOLD0 (FEV1/FVC > 0.7 and FEV1 > 80%), and GOLD1‐4 (FEV1/FVC < 0.7). Measurements and Main 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 and 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 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. Conclusions: 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.

[1]  Raúl San José Estépar,et al.  Respiratory Symptoms in Young Adults and Future Lung Disease. The CARDIA Lung Study , 2018, American journal of respiratory and critical care medicine.

[2]  C. Perry,et al.  Very light smoking and alternative tobacco use among college students. , 2018, Addictive behaviors.

[3]  T. Lam,et al.  Association of adiposity with pulmonary function in older Chinese: Guangzhou Biobank Cohort Study. , 2017, Respiratory medicine.

[4]  A. Bernabé-Ortiz,et al.  Prevalence and risk factors of restrictive spirometry in a cohort of Peruvian adults. , 2017, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[5]  Jaime Perales,et al.  Prevalence and correlates of light and non-daily smoking in Brazil: Results from a nationwide representative survey. , 2017, Drug and alcohol dependence.

[6]  R. Kawasaki,et al.  Impact of restrictive lung disorder on cardiovascular mortality in a general population: The Yamagata (Takahata) study. , 2017, International journal of cardiology.

[7]  Chengcheng Hu,et al.  Low Lung Function in Young Adult Life Is Associated with Early Mortality. , 2017, American journal of respiratory and critical care medicine.

[8]  D. Jarvis,et al.  Health-related quality of life and risk factors associated with spirometric restriction , 2017, European Respiratory Journal.

[9]  A. Kengne,et al.  Determinants of Restrictive Spirometric Pattern in a Sub-Saharan Urban Setting: A Cross-sectional Population-based Study , 2016, The open respiratory medicine journal.

[10]  B. Celli,et al.  Spirometric variability in smokers: transitions in COPD diagnosis in a five-year longitudinal study , 2016, Respiratory Research.

[11]  A. Lindberg,et al.  Restrictive spirometric pattern in the general adult population: Methods of defining the condition and consequences on prevalence. , 2016, Respiratory medicine.

[12]  S. Panico,et al.  Abdominal adiposity is an early marker of pulmonary function impairment: Findings from a Mediterranean Italian female cohort. , 2016, Nutrition, metabolism, and cardiovascular diseases : NMCD.

[13]  I. Janszky,et al.  BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants , 2016, British Medical Journal.

[14]  R. Casaburi,et al.  Phenotype of Spirometric Impairment in an Aging Population. , 2016, American journal of respiratory and critical care medicine.

[15]  J. Soriano,et al.  Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease. , 2015, The New England journal of medicine.

[16]  D. Mannino,et al.  Tuberculosis associates with both airflow obstruction and low lung function: BOLD results , 2015, European Respiratory Journal.

[17]  B. Celli,et al.  Occurrence of respiratory symptoms in persons with restrictive ventilatory impairment compared with persons with chronic obstructive pulmonary disease , 2015, Chronic Respiratory Disease.

[18]  Y. Oh,et al.  Prevalence of Spirometrically-defined Restrictive Ventilatory Defect in Korea: The Fourth-2, 3, and Fifth Korean National Health and Nutrition Examination Survey, 2008-2012 , 2015, Journal of Korean medical science.

[19]  E. Hnizdo,et al.  Change in prevalence of restrictive lung impairment in the U.S. population and associated risk factors: the National Health and Nutrition Examination Survey (NHANES) 1988–1994 and 2007–2010 , 2015, Multidisciplinary Respiratory Medicine.

[20]  T. Gill,et al.  Respiratory Symptoms, Spirometric Respiratory Impairment, and Respiratory Disease in Middle‐Aged and Older Persons , 2015, Journal of the American Geriatrics Society.

[21]  S. Roychoudhury,et al.  Respiratory symptoms, lung function decrement and chronic obstructive pulmonary disease in pre-menopausal Indian women exposed to biomass smoke , 2014, Inhalation toxicology.

[22]  Edwin K Silverman,et al.  Epidemiology, genetics, and subtyping of preserved ratio impaired spirometry (PRISm) in COPDGene , 2014, Respiratory Research.

[23]  J. Concato,et al.  Ethnic differences in respiratory impairment , 2013, Thorax.

[24]  D. Mannino,et al.  Trends in the prevalence of obstructive and restrictive lung function among adults in the United States: findings from the National Health and Nutrition Examination surveys from 1988-1994 to 2007-2010. , 2013, Chest.

[25]  J. Stocks,et al.  Early life influences on the development of chronic obstructive pulmonary disease , 2013, Therapeutic advances in respiratory disease.

[26]  E. Regan,et al.  Automated Telecommunication to Obtain Longitudinal Follow-up in a Multicenter Cross-sectional COPD Study , 2012, COPD.

[27]  D. Mannino,et al.  Primary pulmonary botryomycosis: a bacterial lung infection mimicking lung cancer [Case study]. , 2012, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[28]  Joyce D. Schroeder,et al.  A Combined Pulmonary-Radiology Workshop for Visual Evaluation of COPD: Study Design, Chest CT Findings and Concordance with Quantitative Evaluation , 2012, COPD.

[29]  J. Concato,et al.  Respiratory Impairment and Mortality in Older Persons , 2011, Journal of Investigative Medicine.

[30]  E. Regan,et al.  Clinical and radiographic predictors of GOLD-unclassified smokers in the COPDGene study. , 2011, American journal of respiratory and critical care medicine.

[31]  D. Schroeder,et al.  The nonspecific pulmonary function test: longitudinal follow-up and outcomes. , 2011, Chest.

[32]  E. Regan,et al.  Genetic Epidemiology of COPD (COPDGene) Study Design , 2011, COPD.

[33]  S. Guerra,et al.  Morbidity and mortality associated with the restrictive spirometric pattern: a longitudinal study , 2010, Thorax.

[34]  S. Glantz,et al.  Nondaily and social smoking: an increasingly prevalent pattern. , 2009, Archives of internal medicine.

[35]  Francesco Forastiere,et al.  Restrictive pulmonary dysfunction at spirometry and mortality in the elderly. , 2008, Respiratory medicine.

[36]  D. Mannino,et al.  Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study , 2003, Thorax.

[37]  J L Hankinson,et al.  Spirometric reference values from a sample of the general U.S. population. , 1999, American journal of respiratory and critical care medicine.