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 - 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.
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
VL - 198
SP - 1397
EP - 1405
JO - American Review of Respiratory Disease
JF - American Review of Respiratory Disease
SN - 1073-449X
IS - 11
ER -