Andrei Schwartz1, Nicholas Arnold1, Becky Skinner2, Jacob Simmering2, Michael Eberlein2, Alejandro P Comellas2, Spyridon Fortis3,4. 1. Department of Internal Medicine, Division of General Internal Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa. 2. Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa. 3. Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa. spyridon-fortis@uiowa.edu. 4. Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa.
Abstract
BACKGROUND: Spirometry results can yield a diagnosis of normal air flow, air flow obstruction, or preserved ratio impaired spirometry (PRISm), defined as a reduced FEV1 or FVC in the setting of preserved FEV1/FVC. Previous studies have estimated the prevalence of PRISm to be 7-12%. Our objective was to examine the prevalence of PRISm in a spirometry database and to identify factors associated with PRISm. METHODS: We performed a retrospective analysis of 21,870 spirometries; 1,616 were excluded because of missing data or extremes of age, height, or weight. We calculated the prevalence of PRISm in prebronchodilator and postbronchodilator pulmonary function tests. Subsequently, we calculated the prevalence of PRISm by various age, race, body mass index, and diagnosis categories, as well as by gender and smokers versus nonsmokers. Finally, in the subset of the cohort with FEV1 < lower limit of normal, we performed a multivariable logistic regression analysis to identify factors associated with PRISm. RESULTS: We identified 18,059 prebronchodilator spirometries, and 22.3% of these yielded a PRISm diagnosis. This prevalence remained stable in postbronchodilator spirometries (17.7%), after excluding earlier pulmonary function tests for subjects with multiple pulmonary function tests (20.7% in prebronchodilator and 24.3% in postbronchodilator), and when we limited the analysis to prebronchodilator spirometries that met American Thoracic Society criteria (20.6%). The PRISm prevalence was higher in subjects 45-60 y old (24.4%) and in males (23.7%) versus females (17.9%). The prevalence rose with body mass index and was higher for those with a referral diagnosis of restrictive lung disease (50%). PRISm prevalence was similar between races and smokers versus nonsmokers. In a multivariable analysis, higher % of predicted FEV1 (odds ratio 1.51, 95% CI 1.42-1.60), body mass index (odds ratio 1.52, 95% CI 1.39-1.68), and restrictive lung disease (odds ratio 4.32, 95% CI 2.54-7.57) were associated with a diagnosis of PRISm. Smoking was inversely associated (odds ratio 0.55, 95% CI 0.46-0.65) with PRISm. CONCLUSIONS: In a spirometry database at an academic medical center, the PRISm prevalence was 17-24%, which is higher than previously reported.
BACKGROUND: Spirometry results can yield a diagnosis of normal air flow, air flow obstruction, or preserved ratio impaired spirometry (PRISm), defined as a reduced FEV1 or FVC in the setting of preserved FEV1/FVC. Previous studies have estimated the prevalence of PRISm to be 7-12%. Our objective was to examine the prevalence of PRISm in a spirometry database and to identify factors associated with PRISm. METHODS: We performed a retrospective analysis of 21,870 spirometries; 1,616 were excluded because of missing data or extremes of age, height, or weight. We calculated the prevalence of PRISm in prebronchodilator and postbronchodilator pulmonary function tests. Subsequently, we calculated the prevalence of PRISm by various age, race, body mass index, and diagnosis categories, as well as by gender and smokers versus nonsmokers. Finally, in the subset of the cohort with FEV1 < lower limit of normal, we performed a multivariable logistic regression analysis to identify factors associated with PRISm. RESULTS: We identified 18,059 prebronchodilator spirometries, and 22.3% of these yielded a PRISm diagnosis. This prevalence remained stable in postbronchodilator spirometries (17.7%), after excluding earlier pulmonary function tests for subjects with multiple pulmonary function tests (20.7% in prebronchodilator and 24.3% in postbronchodilator), and when we limited the analysis to prebronchodilator spirometries that met American Thoracic Society criteria (20.6%). The PRISm prevalence was higher in subjects 45-60 y old (24.4%) and in males (23.7%) versus females (17.9%). The prevalence rose with body mass index and was higher for those with a referral diagnosis of restrictive lung disease (50%). PRISm prevalence was similar between races and smokers versus nonsmokers. In a multivariable analysis, higher % of predicted FEV1 (odds ratio 1.51, 95% CI 1.42-1.60), body mass index (odds ratio 1.52, 95% CI 1.39-1.68), and restrictive lung disease (odds ratio 4.32, 95% CI 2.54-7.57) were associated with a diagnosis of PRISm. Smoking was inversely associated (odds ratio 0.55, 95% CI 0.46-0.65) with PRISm. CONCLUSIONS: In a spirometry database at an academic medical center, the PRISm prevalence was 17-24%, which is higher than previously reported.
Authors: Emily S Wan; John E Hokanson; James R Murphy; Elizabeth A Regan; Barry J Make; David A Lynch; James D Crapo; Edwin K Silverman Journal: Am J Respir Crit Care Med Date: 2011-04-14 Impact factor: 21.405
Authors: Surya P Bhatt; James M Wells; Victor Kim; Gerard J Criner; Craig P Hersh; Megan Hardin; William C Bailey; Hrudaya Nath; Young-Il Kim; Marilyn G Foreman; Douglas S Stinson; Carla G Wilson; Stephen I Rennard; Edwin K Silverman; Barry J Make; Mark T Dransfield Journal: Lancet Respir Med Date: 2014-09-09 Impact factor: 30.700
Authors: Sara Renata Alex Wijnant; Emmely De Roos; Maryam Kavousi; Bruno Hugo Stricker; Natalie Terzikhan; Lies Lahousse; Guy G Brusselle Journal: Eur Respir J Date: 2020-01-02 Impact factor: 16.671
Authors: 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 Journal: Am J Respir Crit Care Med Date: 2018-12-01 Impact factor: 30.528
Authors: Emily S Wan; Peter J Castaldi; Michael H Cho; John E Hokanson; Elizabeth A Regan; Barry J Make; Terri H Beaty; MeiLan K Han; Jeffrey L Curtis; Douglas Curran-Everett; David A Lynch; Dawn L DeMeo; James D Crapo; Edwin K Silverman Journal: Respir Res Date: 2014-08-06
Authors: Emily S Wan; John E Hokanson; Elizabeth A Regan; Kendra A Young; Barry J Make; Dawn L DeMeo; Stefanie E Mason; Raul San Jose Estepar; James D Crapo; Edwin K Silverman Journal: Chest Date: 2021-09-27 Impact factor: 9.410
Authors: R Chad Wade; J Patrick Simmons; Adel Boueiz; Andrew Gregory; Emily S Wan; Elizabeth A Regan; Surya P Bhatt; MeiLan K Han; Russell P Bowler; James D Crapo; Edwin K Silverman; George R Washko; Mark T Dransfield; J Michael Wells Journal: Am J Respir Crit Care Med Date: 2021-08-15 Impact factor: 30.528
Authors: Spyridon Fortis; Alejandro P Comellas; Surya P Bhatt; Eric A Hoffman; MeiLan K Han; Nirav R Bhakta; Robert Paine; Bonnie Ronish; Richard E Kanner; Mark Dransfield; Daniel Hoesterey; Russell G Buhr; R Graham Barr; Brett Dolezal; Victor E Ortega; M Bradley Drummond; Mehrdad Arjomandi; Robert J Kaner; Victor Kim; Jeffrey L Curtis; Russell P Bowler; Fernando Martinez; Wassim W Labaki; Christopher B Cooper; Wanda K O'Neal; Gerald Criner; Nadia N Hansel; Jerry A Krishnan; Prescott Woodruff; David Couper; Donald Tashkin; Igor Barjaktarevic Journal: Chest Date: 2021-02-01 Impact factor: 10.262
Authors: James Di Michiel; Julie Gawthorne; Aruna Shivam; Kevin Maruno; Sarah Cohn; Christopher Lemon; Zhixin Liu; Anthony Byrne Journal: Int J Chron Obstruct Pulmon Dis Date: 2021-11-12
Authors: Mohit Bhutani; David B Price; Tonya A Winders; Heinrich Worth; Kevin Gruffydd-Jones; Ruth Tal-Singer; Jaime Correia-de-Sousa; Mark T Dransfield; Rudi Peché; Daiana Stolz; John R Hurst Journal: Adv Ther Date: 2022-04-28 Impact factor: 4.070