Longitudinal phenotypes and mortality in preserved ratio impaired spirometry in the COPDGene study

for the COPDGene Investigators

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1397-1405
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Issue number11
StatePublished - Dec 1 2018

Bibliographical note

Funding Information:
Supported by Department of Veterans Affairs, Rehabilitation Research and Development grant IK2RX002165 and NIH grants NHLBI U01 HL089897, U01 HL089856, and K24 HL 138188. The COPDGene study (NCT00608764) is also supported by the COPD Foundation through contributions made to an Industry Advisory Committee composed of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Pfizer, Siemens, and Sunovion. The funding agencies had no role in the study design; collection, analysis, or interpretation of data; drafting of the manuscript; or decision to submit for publication.

Publisher Copyright:
Copyright © 2018 by the American Thoracic Society.


  • Lung disease epidemiology
  • Numerical data
  • Spirometry classification
  • Spirometry mortality
  • Spirometry statistics


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