TY - JOUR
T1 - Longitudinal phenotypes and mortality in preserved ratio impaired spirometry in the COPDGene study
AU - for the COPDGene Investigators
AU - Wan, Emily S.
AU - Regan, Elizabeth A.
AU - Hokanson, John
AU - Han, Mei Lan K.
AU - Casaburi, Richard
AU - Make, Barry J.
AU - Crapo, James D.
AU - DeMeo, Dawn L.
AU - Silverman, Edwin K.
AU - Fortis, Spyridon
AU - Begum, Ferdouse
AU - Castaldi, Peter J.
AU - Cho, Michael
AU - Boueiz, Adel R.
AU - Foreman, Marilyn G.
AU - Halper-Stromberg, Eitan
AU - Hayden, Lystra P.
AU - Hersh, Craig P.
AU - Hetmanski, Jacqueline
AU - Hobbs, Brian D.
AU - Laird, Nan
AU - Lange, Christoph
AU - Lutz, Sharon M.
AU - McDonald, Merry Lynn
AU - Parker, Margaret M.
AU - Qiao, Dandi
AU - Regan, Elizabeth A.
AU - Won, Sungho
AU - Sakornsakolpat, Phuwanat
AU - Prokopenko, Dmitry
AU - Al Qaisi, Mustafa
AU - Coxson, Harvey O.
AU - Gray, Teresa
AU - Hoffman, Eric A.
AU - Humphries, Stephen
AU - Jacobson, Francine L.
AU - Judy, Philip F.
AU - Kazerooni, Ella A.
AU - Kluiber, Alex
AU - Lynch, David A.
AU - Newell, John D.
AU - Regan, Elizabeth A.
AU - Ross, James C.
AU - Jose Estepar, Raul San
AU - Schroeder, Joyce
AU - Wendt, Christine H
AU - Billings, Joanne L
AU - Begnaud, Abbie
AU - Allen, Tadashi L
N1 - Publisher Copyright:
Copyright © 2018 by the American Thoracic Society.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - 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 (227.3 6 42.1 vs. 233.0 6 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.
AB - 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 (227.3 6 42.1 vs. 233.0 6 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.
KW - Lung disease epidemiology
KW - Numerical data
KW - Spirometry classification
KW - Spirometry mortality
KW - Spirometry statistics
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U2 - 10.1164/rccm.201804-0663OC
DO - 10.1164/rccm.201804-0663OC
M3 - Article
C2 - 29874098
AN - SCOPUS:85054765070
SN - 1073-449X
VL - 198
SP - 1397
EP - 1405
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 11
ER -