Understudied Low-Lung-Function State Tied to Increased Risk of Respiratory Problems and Death

By Reuters Staff

November 12, 2021

NEW YORK (Reuters Health) - A particular pattern of low-scoring lung-capacity tests known as preserved-ratio impaired spirometry or PRISm is associated with respiratory symptoms, cardiovascular comorbidities, and an increased risk of death in older adults, report researchers from the U.K.

In a report in The Lancet Respiratory Medicine, they note that PRISm is a common yet understudied low-lung-function state defined as forced expiratory volume in one second (FEV1) of less than 80% predicted and a FEV1/forced vital capacity (FVC) ratio of 0.70 or higher.

PRISm has been associated with respiratory symptoms and is hypothesized to be a precursor of chronic obstructive pulmonary disease (COPD). However, definitive epidemiological understanding of PRISm has been limited by relatively small selective cohorts with short follow-up.

In what is believed to be the most comprehensive longitudinal study of PRISm to date, Dr. James Dodd and colleagues of the University of Bristol examined the prevalence, risk factors, clinical implications and mortality of PRISm using data from more than 351,000 UK Biobank participants (54% women).

The prevalence of PRISm was (11%) and it was strongly associated with breathlessness (adjusted OR, 2.0; P<0.0001) and cardiovascular disease (adjusted OR, 1.71; P<0.0001).

"PRISm seems to be a distinct lung function trait and not simply a result of increased body-mass index (BMI), underlying asthma, or smoking," the researchers write.

In longitudinal analysis, 241 (12.3%) of 1,973 individuals with PRISm at baseline transitioned to airflow obstruction consistent with COPD, while 50% of individuals reverted to normal spirometry.

PRISm was also associated with increased risk of dying from any cause (adjusted hazard ratio, 1.61; P<0.0001).

"Although for many patients PRISm is transient, it is important to understand which individuals are at risk of progressive lung function abnormalities. Further research into the genetic, structural and functional pathophysiology of PRISm is warranted," the study team writes.

SOURCE: https://bit.ly/3qn5jNV The Lancet Respiratory Medicine, online October 27, 2021.