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Flow diagram. PFT pulmonary function test, GOLD Global Initiative for Chronic Obstructive Lung Disease
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Background
Preserved Ratio Impaired Spirometry (PRISm) is defined as FEV1/FVC ≥ 70% and FEV1 < 80%pred by pulmonary function test (PFT). It has highly prevalence and is associated with increased respiratory symptoms, systemic inflammation, and mortality. However, there are few radiological studies related to PRISm. The purpose of this study was to...
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Metabolic syndrome (MetS) is a constellation of risk factors increasingly present in the world's population. People with this syndrome are at an increased risk of cardiovascular disease and type 2 diabetes mellitus. Moreover, evidence has shown that it affects different organs. MetS and its risk factors are independently associated wit...
Citations
... A population at risk of COPD, denominated as preserved ratio impaired spirometry (PRISm), can present as <80% predicted FEV 1 and ≥0.7 post-bronchodilator FEV 1 /FVC as identified through pulmonary function testing [6,7]. PRISm is considered an independent risk factor for COPD progression [5]. ...
Chronic Obstructive Pulmonary Disease (COPD) is a disease of the lungs characterized by chronic airflow obstruction. Individuals with preserved ratio impaired spirometry (PRISm) may be at risk for developing COPD. This study aimed to characterize PRISm and COPD patients in terms of their immune response and endocrine profile to identify differences extending beyond lung function. The participants performed the clinical assessment, pulmonary function test, and blood collection to determine serum hormone levels and concentrations of cytokine. Differences were observed in the nutritional status, lung function, and comorbidity. There were no differences in IL-6, IL-8, IL-10, IL-12, and TNF levels between PRISm and COPD groups. Both PRISm and COPD patients have lower dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S) levels than controls. Correlation analysis of PRISm and COPD patients revealed positive correlations between serum levels of DHEA-S and DHEA, with forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), which negatively correlated with IL-8 levels. The results indicated that despite differences in lung function parameters, the PRISm and COPD groups exhibited similarities in endocrine profile alterations. This study represents the first attempt to link endocrine with immune markers and lung function in individuals with PRISm.
... 49 Recent studies indicate that it primarily affects the small airways and vessels while sparing lung parenchyma. 49,50 Two studies have shown that 25.1% and 32.6% of individuals with PRISm, respectively progress to spirometryde ned COPD in 5 years. 51,52 Conversely, improvement of spirometry from obstructive pattern to PRISm over time has also been observed. ...
To determine the prevalence and types of spirometry abnormalities among post-COVID-19 patients in Malaysia, with secondary objective focusing on associated factors. Conducted at the COVID-19 Research Clinic, Faculty of Medicine, University Technology MARA, from March 2021 to December 2022, this study included patients three months post-discharge from hospitals following moderate-to-critical COVID-19. Of 408 patients studied, abnormal spirometry was found in 46.8%, with 28.4% exhibiting a restrictive pattern, 17.4% showing preserved ratio impaired spirometry (PRISm), and 1.0% displaying an obstructive pattern. Factors independently associated with abnormal spirometry included older age (OR: 1.0, 95% CI: 1.01–1.04, p = 0.003), underlying cardiovascular disease (OR: 3.5, 95% CI: 1.19–10.47, p = 0.023), history of acute respiratory distress syndrome (p < 0.001), shorter discharge-to-follow-up interval (OR: 0.9, 95% CI: 1.00–1.02, p = 0.035), oxygen desaturation during 6-minute walk test (OR: 1.9, 95% CI: 1.20–3.06, p = 0.007), and presence of consolidation (OR: 8.1, 95% CI: 1.75–37.42, p = 0.008) or ground-glass opacity (OR: 2.6, 95% CI: 1.52–4.30, p < 0.001) on chest X-ray. This study highlights patients recovering from moderate-to-critical COVID-19 often exhibit abnormal spirometry, notably a restrictive pattern and PRISm. Routine spirometry screening for high-risk patients is recommended.
... In the diagnosis of early-stage COPD, CT seems to be more sensitive than traditional pulmonary function tests (PFTs). 60,61 Current PFTs are suboptimal in identifying early lung function impairments and no longer meet the clinical demands for interventions in early-stage diseases. Therefore, we believe that it is crucial to delve into and summarise the radiological characteristics of PRISm on CT scans. ...
... The outcomes revealed that, in contrast to patients with mild-to-moderate COPD, those with PRISm demonstrated notable disparities in parameters related to parenchymal destruction but remained largely congruent in terms of the airway and the majority of vascular parameters. 60 This finding underscores the notion that individuals with PRISm exhibit parenchymal attenuation closer to that of the healthy population, with the principal pathological changes manifesting within the small airways and small vessels. An investigation into the mean lung density (MLD) revealed pronounced variations among the three cohorts (early-stage COPD, PRISm, and normal group). ...
... The MLD of the early-stage COPD cluster was significantly reduced in comparison to the other two, while the PRISm cohort exceeded the controls. [60][61][62] The MLD exhibited marked deviations throughout the spectrum from normal pulmonary function to mild and moderate COPD. The study also accentuated that pulmonary function test maps (PRM) could effectively distinguish between the normal, PRISm, and mild-to-moderate COPD groups, with the PRM pertinent to pulmonary emphysema emerging as an independent predictor for mild-to-moderate COPD. ...
Preserved Ratio Impaired Spirometry (PRISm) manifests notable epidemiological disparities across the globe, with its prevalence and influential factors showcasing pronounced diversities among various geographical territories and demographics. The prevalence of PRISm fluctuates considerably among regions such as Latin America, the United States, and Asian nations, potentially correlating with a myriad of determinants, including socioeconomic status, environmental factors, and lifestyle modalities. Concurrently, the link between PRISm and health risks and other disorders, especially its distinction and interrelation with chronic obstructive pulmonary disease (COPD), has become a pivotal subject of scientific enquiry. Radiographic anomalies, such as perturbations in the pulmonary parenchyma and structural alterations, are posited as salient characteristics of PRISm. Furthermore, PRISm unveils intricate associations with multiple comorbidities, inclusive of hypertension and type 2 diabetes, thereby amplifying the intricacy in comprehending and managing this condition. In this review, we aim to holistically elucidate the epidemiological peculiarities of PRISm, its potential aetiological contributors, its nexus with COPD, and its association with radiographic aberrations and other comorbidities. An integrative understanding of these dimensions will provide pivotal insights for the formulation of more precise and personalised preventative and therapeutic strategies.
... Previous studies in pre-COPD or PRISm patients have been conducted either in the general population [6,[10][11][12][13][14][15][16][17][18] or in clinical cohorts of COPD patient [5,[19][20][21][22][23][24][25][26], so their prevalence, characteristics, treatment, and temporal evolution in a real-life healthcare practice setting are unclear. ...
... Several previous studies have investigated the characteristics and clinical relevance of pre-COPD and PRISm patients in the general population [6,[10][11][12][13][14][15][16][17][18] or in clinical cohorts of COPD patients [5,[19][20][21][22][23][24][25][26]. ...
... Instead, 13% had a normal spirometry (pre-COPD) and 14% PRISm (Figure 1). These figures are in the range of those reported previously in the general population [6,[10][11][12][13][14][15][16][17][18] or COPD patient cohorts [5,[19][20][21][22][23][24]. It is possible that other potential comorbidities (e.g., chronic heart failure / diastolic dysfunction) may mimic the symptoms of COPD and lead to an incorrect diagnosis; unfortunately, NOVELTY does not include any echocardiographic measurement that allow us to explore this possibility, albeit it may be of note that PRISm patients had a higher reported incidence of coronary artery disease (Table 1). ...
Background
The diagnosis of Chronic Obstructive Pulmonary Disease (COPD) requires the demonstration of non-fully reversible airflow limitation by spirometry in the appropriate clinical context. Yet, there are patients with symptoms and relevant exposures suggestive of COPD with either normal spirometry (pre-COPD) or Preserved Ratio but Impaired Spirometry (PRISm). Their prevalence, clinical characteristics and associated outcomes in a real-life setting are unclear.
Methods
To investigate them, we studied 3183 patients diagnosed of COPD by their attending physician included in the NOVELTY study ( NCT02760329 ), a global, 3-year, observational, real-life cohort that included patients recruited from both primary and specialist care clinics in 18 countries.
Results
We found that: (1) about a quarter of patients diagnosed with (and treated for) COPD in real-life did not fulfil the spirometric diagnostic criteria recommended by GOLD, and could be instead categorized as pre-COPD (13%) or PRISm (14%); (2) disease burden (symptoms and exacerbations) was highest in GOLD 3–4 patients (exacerbations per person-year [PPY]: 0.82) and lower but similar in those in GOLD 1–2, pre-COPD and PRISm (exacerbations PPY range: 0.27-0.43); (3) lung function decline was highest in pre-COPD and GOLD 1–2, and much less pronounced in PRISm and GOLD 3-4; (4) ; PRISm and pre-COPD were not stable diagnostic categories and change substantially over time; and, (5) all-cause mortality was highest in GOLD 3–4, lowest in pre-COPD, and intermediate and similar in GOLD 1–2 and PRISm.
Conclusions
Patients diagnosed COPD in a real-life clinical setting present great diversity in symptom burden, progression, and survival, warranting medical attention.
... Given the intricacy of PRISm and COPD development [36], it is noteworthy that many of the underlying functional changes in PRISm can be more accurately visualized using sensitive techniques such as body-plethysmography, oscillometry, and advanced imaging modalities [25,37,38]. ...
Background
Preserved Ratio Impaired Spirometry (PRISm) is associated with increased cardiovascular disease (CVD) risk and mortality. However, a causal relationship between PRISm and CVD remains unclear. We investigated the progression of coronary artery calcium (CAC) scores based on the presence of PRISm and reduced forced vital capacity (FVC).
Methods
This retrospective cohort study included 11 420 participants ≥40 years with forced expiratory volume in 1 s (FEV 1 )/FVC ≥0.7, who underwent at least two health screening examinations with coronary CT scan between 2003 and 2020, and are without a history of CVD or interstitial lung disease. Participants with PRISm, defined as FEV 1 /FVC≥0.7 and FEV 1 <80% predicted, were further divided by low FVC (FVC <80% predicted). We estimated the 5-year progression rates of CAC by comparing participants with and without PRISm at baseline using mixed linear models.
Results
Of the 11 420 participants, 8536 (75%), 811 (7%), and 2073 (18%) had normal spirometry, PRISm with normal FVC, and PRISm with low FVC, respectively. During the mean follow-up of 6.0 years (range 0.5–17.2), the multivariable adjusted ratio of 5-year CAC progression rates comparing participants with PRISm with those with normal spirometry was 1.08 (95% CI, 1.04–1.13). This rate was faster in participants with PRISm with low FVC (1.21; 95% CI, 1.12–1.30) than in those with normal FVC.
Conclusion
In this longitudinal cohort study of subjects without a history of CVD, PRISm was significantly associated with CAC progression, which was more evident in the group with PRISm and low FVC.
... This not only identifies and quantifies different pathological bases of air trapping components but also provides their spatial distribution, which is its unique advantage. PRM fSAD has been proven to have a good correlation with lung function indicators such as FEV1, FEV1/FVC, total lung capacity, and residual volume [11,25,39]. Vasilescu et al. [28] proved through lung tissue micro-CT that PRM fSAD is closely related to the loss, narrowing, and obstruction areas of terminal bronchioles. ...
Objectives
Parametric response mapping (PRM) enables the evaluation of small airway disease (SAD) at the voxel level, but requires both inspiratory and expiratory chest CT scans. We hypothesize that deep learning PRM from inspiratory chest CT scans can effectively evaluate SAD in individuals with normal spirometry.
Methods
We included 537 participants with normal spirometry, a history of smoking or secondhand smoke exposure, and divided them into training, tuning, and test sets. A cascaded generative adversarial network generated expiratory CT from inspiratory CT, followed by a UNet-like network predicting PRM using real inspiratory CT and generated expiratory CT. The performance of the prediction is evaluated using SSIM, RMSE and dice coefficients. Pearson correlation evaluated the correlation between predicted and ground truth PRM. ROC curves evaluated predicted PRMfSAD (the volume percentage of functional small airway disease, fSAD) performance in stratifying SAD.
Results
Our method can generate expiratory CT of good quality (SSIM 0.86, RMSE 80.13 HU). The predicted PRM dice coefficients for normal lung, emphysema, and fSAD regions are 0.85, 0.63, and 0.51, respectively. The volume percentages of emphysema and fSAD showed good correlation between predicted and ground truth PRM (|r| were 0.97 and 0.64, respectively, p < 0.05). Predicted PRMfSAD showed good SAD stratification performance with ground truth PRMfSAD at thresholds of 15%, 20% and 25% (AUCs were 0.84, 0.78, and 0.84, respectively, p < 0.001).
Conclusion
Our deep learning method generates high-quality PRM using inspiratory chest CT and effectively stratifies SAD in individuals with normal spirometry.
... Previous studies in pre-COPD or PRISm patients have been conducted either in the general population [6,[10][11][12][13][14][15][16][17][18] or in clinical cohorts of COPD patient [5,[19][20][21][22][23][24][25][26], so their prevalence, characteristics, treatment, and temporal evolution in a real-life healthcare practice setting are unclear. ...
... Several previous studies have investigated the characteristics and clinical relevance of pre-COPD and PRISm patients in the general population [6,[10][11][12][13][14][15][16][17][18] or in clinical cohorts of COPD patients [5,[19][20][21][22][23][24][25][26]. ...
... Instead, 13% had a normal spirometry (pre-COPD) and 14% PRISm (Figure 1). These figures are in the range of those reported previously in the general population [6,[10][11][12][13][14][15][16][17][18] or COPD patient cohorts [5,[19][20][21][22][23][24]. It is possible that other potential comorbidities (e.g., chronic heart failure / diastolic dysfunction) may mimic the symptoms of COPD and lead to an incorrect diagnosis; unfortunately, NOVELTY does not include any echocardiographic measurement that allow us to explore this possibility, albeit it may be of note that PRISm patients had a higher reported incidence of coronary artery disease (Table 1). ...
