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

• Published in: American journal of respiratory and critical care medicine Vol. 198; no. 11; pp. 1397 - 1405
• Main Authors: Wan, Emily S., Fortis, Spyridon, Regan, Elizabeth A., Hokanson, John, Han, MeiLan K., Casaburi, Richard, Make, Barry J., Crapo, James D., DeMeo, Dawn L., Silverman, Edwin K., Beaty, Terri, Begum, Ferdouse, Castaldi, Peter J., Cho, Michael, Boueiz, Adel R., Foreman, Marilyn G., Halper-Stromberg, Eitan, Hayden, Lystra P., Hersh, Craig P., Hetmanski, Jacqueline, Hobbs, Brian D., Hokanson, John E., Laird, Nan, Lange, Christoph, Lutz, Sharon M., McDonald, Merry-Lynn, Parker, Margaret M., Qiao, Dandi, Won, Sungho, Sakornsakolpat, Phuwanat, Prokopenko, Dmitry, Al Qaisi, Mustafa, Coxson, Harvey O., Gray, Teresa, Hoffman, Eric A., Humphries, Stephen, Jacobson, Francine L., Judy, Philip F., Kazerooni, Ella A., Kluiber, Alex, Lynch, David A., Newell, John D., Ross, James C., San Jose Estepar, Raul, Schroeder, Joyce, Sieren, Jered, Stinson, Douglas, Stoel, Berend C., Tschirren, Juerg, Van Beek, Edwin, van Ginneken, Bram, van Rikxoort, Eva, Washko, George, Wilson, Carla G., Jensen, Robert, Everett, Douglas, Crooks, Jim, Moore, Camille, Strand, Matt, Hughes, John, Kinney, Gregory, Pratte, Katherine, Young, Kendra A., Bhatt, Surya, Bon, Jessica, Make, Barry, Martinez, Carlos, Murray, Susan, Regan, Elizabeth, Soler, Xavier, Bowler, Russell P., Kechris, Katerina, Banaei-Kashani, Farnoush, Curtis, Jeffrey L., Martinez, Carlos H., Pernicano, Perry G., Hanania, Nicola, Alapat, Philip, Atik, Mustafa, Bandi, Venkata, Boriek, Aladin, Guntupalli, Kalpatha, Guy, Elizabeth, Nachiappan, Arun, Parulekar, Amit, Hersh, Craig, Barr, R. Graham, Austin, John, D’Souza, Belinda, Pearson, Gregory D. N., Rozenshtein, Anna, Thomashow, Byron, MacIntyre, Neil
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01.12.2018
• Subjects: Aged; Aged, 80 and over; Bronchodilators; Chronic obstructive pulmonary disease; Epidemiology; Female; Follow-Up Studies; Humans; Longitudinal Studies; Lung - physiopathology; Lung diseases; Male; Medical imaging; Middle Aged; Mortality; Original; Phenotype; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - physiopathology; Questionnaires; Respiratory Function Tests - methods; Respiratory Function Tests - statistics & numerical data; Risk Factors; Smokers - statistics & numerical data; Smoking; Spirometry - methods; Surveys and Questionnaires; Survival analysis; Systematic review; United States - epidemiology; Young adults; United States; United States > US; lung disease epidemiology; spirometry mortality; spirometry statistics and numerical data; spirometry classification
• ISSN: 1073-449X; 1535-4970; 1535-4970
• DOI: 10.1164/rccm.201804-0663OC

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.