Jacob Louis Marott1, Truls Sylvan Ingebrigtsen2, Yunus Çolak3, Jørgen Vestbo4,5, Peter Lange6,7. 1. Frederiksberg Hospital, The Copenhagen City Heart Study, Copenhagen, Denmark. 2. Roskilde Sygehus, 53140, Respiratory Section, Department of Internal Medicine, Roskilde, Denmark. 3. Herlev and Gentofte Hospital, Copenhagen University Hospital , Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev, Denmark. 4. The University of Manchester, 5292, Division of Infection, Immunity and Respiratory Medicine, Manchester, United Kingdom of Great Britain and Northern Ireland. 5. Manchester University NHS Foundation Trust, 5293, North West Lung Centre, Manchester, United Kingdom of Great Britain and Northern Ireland. 6. University of Copenhagen, Department of Public Health, Copenhagen, Denmark. 7. HVidovre Hospital, Respiratory Medicine, Hvidovre, Denmark; peter.lange@sund.ku.dk.
Abstract
RATIONALE: Natural history of Preserved Ratio Impaired Spirometry (PRISm), often defined as FEV1/FVC≥lower limit of normal and FEV1<80% of predicted value, is not well-described. OBJECTIVE: To investigate natural history and long-term prognosis of PRISm trajectories: persistent PRISm trajectory (individuals with PRISm both as young and as middle-aged); normal-to-PRISm trajectory (individuals developing PRISm from normal spirometry in young adulthood); and PRISm-to-normal trajectory (individuals recovering from PRISm in young adulthood by normalizing spirometry while middle-aged). METHODS: We followed 1160 individuals aged 20-40 years from the Copenhagen City Heart Study from 1976-83 until 2001-03 to determine their lung function trajectory: 72 had persistent PRISm trajectory, 76 normal-to-PRISm trajectory, 155 PRISm-to-normal trajectory, and 857 had normal trajectory. From 2001-03 until 2018, we determined risk of cardiopulmonary disease and death. MEASUREMENTS AND MAIN RESULTS: We recorded 198 admissions for heart disease, 143 for pneumonia, and 64 for COPD, and 171 deaths. Compared to individuals with normal trajectory, hazards ratios for individuals with persistent PRISm trajectory were 1.55 (95% CI, 0.91-2.65) for heart disease admission, 2.86 (1.70-4.83) for pneumonia admission, 6.57 (3.41-12.66) for COPD admission, and 3.68 (2.38-5.68) for all-cause mortality. Corresponding hazards ratios for individuals with normal-to-PRISm trajectory were 1.91 (1.24-2.95), 2.74 (1.70-4.42), 6.03 (3.41-10.64), and 2.96 (1.94-4.51), respectively. Prognosis of individuals with PRISm-to-normal trajectory did not differ from those with normal trajectory. CONCLUSIONS: PRISm in middle-aged individuals is associated with increased risk of cardiopulmonary disease and all-cause mortality, but individuals who recover from PRISm during their adult life are no longer at increased risk.
RATIONALE: Natural history of Preserved Ratio Impaired Spirometry (PRISm), often defined as FEV1/FVC≥lower limit of normal and FEV1<80% of predicted value, is not well-described. OBJECTIVE: To investigate natural history and long-term prognosis of PRISm trajectories: persistent PRISm trajectory (individuals with PRISm both as young and as middle-aged); normal-to-PRISm trajectory (individuals developing PRISm from normal spirometry in young adulthood); and PRISm-to-normal trajectory (individuals recovering from PRISm in young adulthood by normalizing spirometry while middle-aged). METHODS: We followed 1160 individuals aged 20-40 years from the Copenhagen City Heart Study from 1976-83 until 2001-03 to determine their lung function trajectory: 72 had persistent PRISm trajectory, 76 normal-to-PRISm trajectory, 155 PRISm-to-normal trajectory, and 857 had normal trajectory. From 2001-03 until 2018, we determined risk of cardiopulmonary disease and death. MEASUREMENTS AND MAIN RESULTS: We recorded 198 admissions for heart disease, 143 for pneumonia, and 64 for COPD, and 171 deaths. Compared to individuals with normal trajectory, hazards ratios for individuals with persistent PRISm trajectory were 1.55 (95% CI, 0.91-2.65) for heart disease admission, 2.86 (1.70-4.83) for pneumonia admission, 6.57 (3.41-12.66) for COPD admission, and 3.68 (2.38-5.68) for all-cause mortality. Corresponding hazards ratios for individuals with normal-to-PRISm trajectory were 1.91 (1.24-2.95), 2.74 (1.70-4.42), 6.03 (3.41-10.64), and 2.96 (1.94-4.51), respectively. Prognosis of individuals with PRISm-to-normal trajectory did not differ from those with normal trajectory. CONCLUSIONS: PRISm in middle-aged individuals is associated with increased risk of cardiopulmonary disease and all-cause mortality, but individuals who recover from PRISm during their adult life are no longer at increased risk.
Entities:
Keywords:
Morbidity; Mortality; Preserved Ratio Impaired Spirometry (PRISm); Trajectories
Authors: Emily S Wan; Pallavi Balte; Joseph E Schwartz; Surya P Bhatt; Patricia A Cassano; David Couper; Martha L Daviglus; Mark T Dransfield; Sina A Gharib; David R Jacobs; Ravi Kalhan; Stephanie J London; Ana Navas-Acien; George T O'Connor; Jason L Sanders; Benjamin M Smith; Wendy White; Sachin Yende; Elizabeth C Oelsner Journal: JAMA Date: 2021-12-14 Impact factor: 157.335