Evans Alexander, Tarabichi Yasir, Pace Wilson D, Make Barry, Bushell Nicholas, Carter Victoria, Chang Ku-Lang, Fox Chester, Han MeiLan K, Kaplan Alan, Kocks Janwillem W H, Le Lievre Chantal, Roussos Alexander, Skolnik Neil, Soriano Joan B, Yawn Barbara P, Price David
Observational and Pragmatic Research Institute, Singapore, Singapore.
Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH, USA.
Pragmat Obs Res. 2024 Dec 13;15:221-232. doi: 10.2147/POR.S478721. eCollection 2024.
Preserved ratio impaired spirometry (PRISm) represents a population with spirometry results that do not meet standardized COPD obstruction criteria, yet present with high respiratory symptom burden and might benefit from respiratory management and treatment. We aimed to determine prevalence of PRISm in US primary care patients diagnosed with COPD, describe their demographic, clinical, and CT scan characteristics.
An observational registry study utilizing the US APEX COPD registry, composed of patients diagnosed with COPD aged 35+ years. Demographic and clinical data were collected from EHRs and complemented by questionnaires. Multivariable logistic regression was performed to assess whether PRISm predicts lung function decline.
Prevalence of PRISm within a primary care population clinically diagnosed with COPD was 23.6% (678/2866, 95% CI 22.0-25.1). Those with PRISm were more likely female (55.9% vs 46.9%), younger (66.3±11.1 vs 69.2±10.3 years), with a greater mean BMI (33.5±9.2 vs 27.8±7.2 kg/m), more often African American or Hispanic (37.2% vs 26.3%), and with fewer current smokers (33.1% vs 36.8%) when compared to those meeting COPD spirometry criteria (all p<0.05). Compared to COPD GOLD 0 patients, individuals with PRISm had greater BMI (33.5±9.2 vs 30.6±7.8), and were more likely current smokers (33.1% vs 23.4%), both p<0.05. Patients with PRISm had similar respiratory symptoms (chronic bronchitis, CAT, and mMRC) to overall COPD patients, but more frequently than GOLD 0 COPD patients (p<0.01). Emphysema was more commonly reported in CT scans from patients with PRISm 70.3% (260/369, 95% CI 65.8-75.3) than those with GOLD 0 COPD 64.1% (218/340, 95% CI 58.8-69.2) (p<0.05). PRISm status was not predictive of lung function decline.
One in four primary care patients with clinically diagnosed COPD in a large US registry fulfil the spirometric definition of PRISm rather than COPD, but suffers from emphysema in CT and significant respiratory symptoms.
肺功能测定保存率受损（PRISm）人群的肺功能测定结果不符合慢性阻塞性肺疾病（COPD）标准化阻塞标准，但呼吸症状负担高，可能从呼吸管理和治疗中获益。我们旨在确定美国初级保健中诊断为COPD的患者中PRISm的患病率，描述其人口统计学、临床和CT扫描特征。
一项观察性登记研究，利用美国APEX COPD登记处，纳入年龄35岁及以上诊断为COPD的患者。从电子健康记录中收集人口统计学和临床数据，并通过问卷调查进行补充。进行多变量逻辑回归以评估PRISm是否可预测肺功能下降。
临床诊断为COPD的初级保健人群中PRISm的患病率为23.6%（678/2866，95%CI 22.0-25.1）。与符合COPD肺功能测定标准的患者相比，PRISm患者更可能为女性（55.9%对46.9%）、更年轻（66.3±11.1岁对69.2±10.3岁）、平均BMI更高（33.5±9.2对27.8±7.2kg/m²）、非裔美国人或西班牙裔比例更高（37.2%对26.3%），且当前吸烟者更少（33.1%对36.8%）（所有p<0.05）。与COPD GOLD 0级患者相比，PRISm患者BMI更高（33.5±9.2对30.6±7.8），且当前吸烟者更可能（33.1%对23.4%），两者p<0.05。PRISm患者的呼吸症状（慢性支气管炎、CAT和mMRC）与总体COPD患者相似，但比GOLD 0级COPD患者更频繁（p<0.01）。PRISm患者的CT扫描中肺气肿的报告率为70.3%（260/369，95%CI 65.8-75.3），高于GOLD 0级COPD患者的64.1%（218/340，95%CI 58.8-69.2）（p<0.05）。PRISm状态不能预测肺功能下降。
在美国一个大型登记处中，四分之一临床诊断为COPD的初级保健患者符合PRISm而非COPD的肺功能测定定义，但CT显示有肺气肿且有明显的呼吸症状。
