Longitudinal Phenotypes and Mortality in Preserved Ratio Impaired Spirometry in the COPDGene Study
Emily S Wan, Spyridon Fortis, Elizabeth A Regan, John Hokanson, MeiLan K Han, Richard Casaburi, Barry J Make, James D Crapo, Dawn L DeMeo, Edwin K Silverman, COPDGene Investigators, James D Crapo, Edwin K Silverman, Barry J Make, Elizabeth A Regan, Terri Beaty, Ferdouse Begum, Peter J Castaldi, Michael Cho, Dawn L DeMeo, Adel R Boueiz, Marilyn G Foreman, Eitan Halper-Stromberg, Lystra P Hayden, Craig P Hersh, Jacqueline Hetmanski, Brian D Hobbs, John E Hokanson, Nan Laird, Christoph Lange, Sharon M Lutz, Merry-Lynn McDonald, Margaret M Parker, Dandi Qiao, Elizabeth A Regan, Edwin K Silverman, Emily S Wan, Sungho Won, Phuwanat Sakornsakolpat, Dmitry Prokopenko, Mustafa Al Qaisi, Harvey O Coxson, Teresa Gray, MeiLan K Han, Eric A Hoffman, Stephen Humphries, Francine L Jacobson, Philip F Judy, Ella A Kazerooni, Alex Kluiber, David A Lynch, John D Newell Jr, Elizabeth A Regan, James C Ross, Raul San Jose Estepar, Joyce Schroeder, Jered Sieren, Douglas Stinson, Berend C Stoel, Juerg Tschirren, Edwin Van Beek, Bram van Ginneken, Eva van Rikxoort, George Washko, Carla G Wilson, Robert Jensen, Douglas Everett, Jim Crooks, Camille Moore, Matt Strand, Carla G Wilson, John E Hokanson, John Hughes, Gregory Kinney, Sharon M Lutz, Katherine Pratte, Kendra A Young, Surya Bhatt, Jessica Bon, MeiLan K Han, Barry Make, Carlos Martinez, Susan Murray, Elizabeth Regan, Xavier Soler, Carla G Wilson, Russell P Bowler, Katerina Kechris, Farnoush Banaei-Kashani, Jeffrey L Curtis, Carlos H Martinez, Perry G Pernicano, Nicola Hanania, Philip Alapat, Mustafa Atik, Venkata Bandi, Aladin Boriek, Kalpatha Guntupalli, Elizabeth Guy, Arun Nachiappan, Amit Parulekar, Dawn L DeMeo, Craig Hersh, Francine L Jacobson, George Washko, R Graham Barr, John Austin, Belinda D'Souza, Gregory D N Pearson, Anna Rozenshtein, Byron Thomashow, Neil MacIntyre Jr, H Page McAdams, Lacey Washington, Charlene McEvoy, Joseph Tashjian, Robert Wise, Robert Brown, Nadia N Hansel, Karen Horton, Allison Lambert, Nirupama Putcha, Richard Casaburi, Alessandra Adami, Matthew Budoff, Hans Fischer, Janos Porszasz, Harry Rossiter, William Stringer, Amir Sharafkhaneh, Charlie Lan, Christine Wendt, Brian Bell, Marilyn G Foreman, Eugene Berkowitz, Gloria Westney, Russell Bowler, David A Lynch, Richard Rosiello, David Pace, Gerard Criner, David Ciccolella, Francis Cordova, Chandra Dass, Gilbert D'Alonzo, Parag Desai, Michael Jacobs, Steven Kelsen, Victor Kim, A James Mamary, Nathaniel Marchetti, Aditi Satti, Kartik Shenoy, Robert M Steiner, Alex Swift, Irene Swift, Maria Elena Vega-Sanchez, Mark Dransfield, William Bailey, Surya Bhatt, Anand Iyer, Hrudaya Nath, J Michael Wells, Joe Ramsdell, Paul Friedman, Xavier Soler, Andrew Yen, Alejandro P Comellas, Karin F Hoth, John Newell Jr, Brad Thompson, MeiLan K Han, Ella Kazerooni, Carlos H Martinez, Joanne Billings, Abbie Begnaud, Tadashi Allen, Frank Sciurba, Jessica Bon, Divay Chandra, Carl Fuhrman, Joel Weissfeld, Antonio Anzueto, Sandra Adams, Diego Maselli-Caceres, Mario E Ruiz, Emily S Wan, Spyridon Fortis, Elizabeth A Regan, John Hokanson, MeiLan K Han, Richard Casaburi, Barry J Make, James D Crapo, Dawn L DeMeo, Edwin K Silverman, COPDGene Investigators, James D Crapo, Edwin K Silverman, Barry J Make, Elizabeth A Regan, Terri Beaty, Ferdouse Begum, Peter J Castaldi, Michael Cho, Dawn L DeMeo, Adel R Boueiz, Marilyn G Foreman, Eitan Halper-Stromberg, Lystra P Hayden, Craig P Hersh, Jacqueline Hetmanski, Brian D Hobbs, John E Hokanson, Nan Laird, Christoph Lange, Sharon M Lutz, Merry-Lynn McDonald, Margaret M Parker, Dandi Qiao, Elizabeth A Regan, Edwin K Silverman, Emily S Wan, Sungho Won, Phuwanat Sakornsakolpat, Dmitry Prokopenko, Mustafa Al Qaisi, Harvey O Coxson, Teresa Gray, MeiLan K Han, Eric A Hoffman, Stephen Humphries, Francine L Jacobson, Philip F Judy, Ella A Kazerooni, Alex Kluiber, David A Lynch, John D Newell Jr, Elizabeth A Regan, James C Ross, Raul San Jose Estepar, Joyce Schroeder, Jered Sieren, Douglas Stinson, Berend C Stoel, Juerg Tschirren, Edwin Van Beek, Bram van Ginneken, Eva van Rikxoort, George Washko, Carla G Wilson, Robert Jensen, Douglas Everett, Jim Crooks, Camille Moore, Matt Strand, Carla G Wilson, John E Hokanson, John Hughes, Gregory Kinney, Sharon M Lutz, Katherine Pratte, Kendra A Young, Surya Bhatt, Jessica Bon, MeiLan K Han, Barry Make, Carlos Martinez, Susan Murray, Elizabeth Regan, Xavier Soler, Carla G Wilson, Russell P Bowler, Katerina Kechris, Farnoush Banaei-Kashani, Jeffrey L Curtis, Carlos H Martinez, Perry G Pernicano, Nicola Hanania, Philip Alapat, Mustafa Atik, Venkata Bandi, Aladin Boriek, Kalpatha Guntupalli, Elizabeth Guy, Arun Nachiappan, Amit Parulekar, Dawn L DeMeo, Craig Hersh, Francine L Jacobson, George Washko, R Graham Barr, John Austin, Belinda D'Souza, Gregory D N Pearson, Anna Rozenshtein, Byron Thomashow, Neil MacIntyre Jr, H Page McAdams, Lacey Washington, Charlene McEvoy, Joseph Tashjian, Robert Wise, Robert Brown, Nadia N Hansel, Karen Horton, Allison Lambert, Nirupama Putcha, Richard Casaburi, Alessandra Adami, Matthew Budoff, Hans Fischer, Janos Porszasz, Harry Rossiter, William Stringer, Amir Sharafkhaneh, Charlie Lan, Christine Wendt, Brian Bell, Marilyn G Foreman, Eugene Berkowitz, Gloria Westney, Russell Bowler, David A Lynch, Richard Rosiello, David Pace, Gerard Criner, David Ciccolella, Francis Cordova, Chandra Dass, Gilbert D'Alonzo, Parag Desai, Michael Jacobs, Steven Kelsen, Victor Kim, A James Mamary, Nathaniel Marchetti, Aditi Satti, Kartik Shenoy, Robert M Steiner, Alex Swift, Irene Swift, Maria Elena Vega-Sanchez, Mark Dransfield, William Bailey, Surya Bhatt, Anand Iyer, Hrudaya Nath, J Michael Wells, Joe Ramsdell, Paul Friedman, Xavier Soler, Andrew Yen, Alejandro P Comellas, Karin F Hoth, John Newell Jr, Brad Thompson, MeiLan K Han, Ella Kazerooni, Carlos H Martinez, Joanne Billings, Abbie Begnaud, Tadashi Allen, Frank Sciurba, Jessica Bon, Divay Chandra, Carl Fuhrman, Joel Weissfeld, Antonio Anzueto, Sandra Adams, Diego Maselli-Caceres, Mario E Ruiz
Abstract
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 (-27.3 ± 42.1 vs. -33.0 ± 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.
Trial registration: ClinicalTrials.gov NCT00608764.
Keywords: lung disease epidemiology; spirometry classification; spirometry mortality; spirometry statistics and numerical data.
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Source: PubMed