Different Risks of Mortality and Longitudinal Transition Trajectories in New Potential Subtypes of the Preserved Ratio Impaired Spirometry: Evidence From the English Longitudinal Study of Aging

Background: Preserved ratio impaired spirometry (PRISm), characterized by the decreased forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC) with a preserved FEV 1 /FVC ratio, is highly prevalent and heterogeneous. We aimed to identify the subtypes of PRISm and examine their diff...

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Published inFrontiers in medicine Vol. 8; p. 755855
Main Authors He, Di, Sun, Yilan, Gao, Musong, Wu, Qiong, Cheng, Zongxue, Li, Jun, Zhou, Yong, Ying, Kejing, Zhu, Yimin
Format Journal Article
LanguageEnglish
Published Frontiers Media S.A 11.11.2021
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Summary:Background: Preserved ratio impaired spirometry (PRISm), characterized by the decreased forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC) with a preserved FEV 1 /FVC ratio, is highly prevalent and heterogeneous. We aimed to identify the subtypes of PRISm and examine their differences in clinical characteristics, long-term mortality risks, and longitudinal transition trajectories. Methods: A total of 6,616 eligible subjects were included from the English longitudinal study of aging. Two subtypes of the PRISm were identified as mild PRISm (either of FEV 1 and FVC <80% predicted value, FEV 1 /FVC ≥0.7) and severe PRISm (both FEV 1 and FVC <80% predicted values, FEV 1 /FVC ≥0.7). Normal spirometry was defined as both FEV 1 and FVC ≥80% predicted values and FEV 1 /FVC ≥0.7. Hazard ratios (HRs) and 95% CIs were calculated by the multiple Cox regression models. Longitudinal transition trajectories were described with repeated spirometry data. Results: At baseline, severe PRISm had increased respiratory symptoms, including higher percentages of phlegm, wheezing, dyspnea, chronic bronchitis, and emphysema than mild PRISm. After an average of 7.7 years of follow-up, severe PRISm significantly increased the risks of all-cause mortality (HR=1.91, 95%CI = 1.58–2.31), respiratory mortality (HR = 6.02, 95%CI = 2.83–12.84), and CVD mortality (HR = 2.11, 95%CI = 1.42–3.13) compared with the normal spirometry, but no significantly increased risks were found for mild PRISm. In the two longitudinal transitions, mild PRISm tended to transition toward normal spirometry (40.2 and 54.7%), but severe PRISm tended to maintain the status (42.4 and 30.4%) or transition toward Global Initiative for Chronic Obstructive Lung Disease (GOLD)2–4 (28.3 and 33.9%). Conclusion: Two subtypes of PRISm were identified. Severe PRISm had increased respiratory symptoms, higher mortality risks, and a higher probability of progressing to GOLD2–4 than mild PRISm. These findings provided new evidence for the stratified management of PRISm.
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Reviewed by: Spyridon Fortis, The University of Iowa, United States; Gregory Kinney, University of Colorado Denver, United States
Edited by: Chin Kook Rhee, The Catholic University of Korea, South Korea
These authors have contributed equally to this work and share first authorship
This article was submitted to Pulmonary Medicine, a section of the journal Frontiers in Medicine
ISSN:2296-858X
2296-858X
DOI:10.3389/fmed.2021.755855