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. 2021 Nov 11:8:755855.
doi: 10.3389/fmed.2021.755855. eCollection 2021.

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

Di He  1   2 , Yilan Sun  3 , Musong Gao  2 , Qiong Wu  1   2 , Zongxue Cheng  1   2 , Jun Li  1   2 , Yong Zhou  1 , Kejing Ying  1 , Yimin Zhu  1   2
Affiliations

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

Di He et al. Front Med (Lausanne). .

Abstract

Background: Preserved ratio impaired spirometry (PRISm), characterized by the decreased forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) with a preserved FEV1/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 FEV1 and FVC <80% predicted value, FEV1/FVC ≥0.7) and severe PRISm (both FEV1 and FVC <80% predicted values, FEV1/FVC ≥0.7). Normal spirometry was defined as both FEV1 and FVC ≥80% predicted values and FEV1/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.

Keywords: heterogeneity; longitudinal transition; lung function; mortality; preserved ratio impaired spirometry; subtypes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study population selection procedure. ELSA, English longitudinal study of aging.
See this image and copyright information in PMC

References

    1. Guerra S, Sherrill DL, Venker C, Ceccato CM, Halonen M, Martinez FD. Morbidity and mortality associated with the restrictive spirometric pattern: a longitudinal study. Thorax. (2010) 65:499–504. 10.1136/thx.2009.126052 - DOI - PMC - PubMed
    1. Pan J, Adab P, Jiang CQ, Zhang WS, Zhu F, Jin YL, et al. . All-cause and cause-specific mortality from restrictive and obstructive spirometric patterns in Chinese adults with and without dyspnea: Guangzhou Biobank Cohort Study. Respir Med. (2019) 151:66–80. 10.1016/j.rmed.2019.04.002 - DOI - PubMed
    1. Wan ES, Hokanson JE, Murphy JR, Regan EA, Make BJ, Lynch DA, et al. . Clinical and radiographic predictors of GOLD-unclassified smokers in the COPDGene study. Am J Respir Crit Care Med. (2011) 184:57–63. 10.1164/rccm.201101-0021OC - DOI - PMC - PubMed
    1. Hyatt RE, Cowl CT, Bjoraker JA, Scanlon PD. Conditions associated with an abnormal nonspecific pattern of pulmonary function tests. Chest. (2009) 135:419–24. 10.1378/chest.08-1235 - DOI - PubMed
    1. Wijnant SRA, De Roos E, Kavousi M, Stricker BH, Terzikhan N, Lahousse L, et al. . Trajectory and mortality of preserved ratio impaired spirometry: the Rotterdam Study. Eur Respir J. (2020) 55:1901217. 10.1183/13993003.congress-2019.PA4421 - DOI - PubMed

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